Efficacy and hematologic toxicity of salvage chemotherapy following stem cell-supported high-dose chemotherapy in women with recurrent ovarian cancer

Objective. The objective of this study was to determine the efficacy and he matologic toxicity of salvage chemotherapy in patients with recurrent ovari an cancer following high-dose chemotherapy and peripheral blood stem cell t ransplantation (PBSCT), Methods. A retrospective analysis of 19 Massachusetts General Hospital case records of women with relapsed ovarian cancer following PBSCT was conducte d. Results. Between February 1996 and September 1998, 24 women with ovarian ca ncer were treated with PBSCT. Nine patients were treated with an upfront PB SCT regimen to consolidate first-line chemotherapy and 15 patients were tre ated with PBSCT after a median of two lines (range: 1-3) of prior chemother apy. Sixteen patients presented with relapsed disease at a median of 230 da ys post-PBSCT and 3 patients had persistent disease through high-dose chemo therapy. Each of these 19 patients has been treated with salvage chemothera py following PBSCT, Patients received one of six different first-line salva ge chemotherapy regimens, Sixteen of nineteen patients are alive a median o f 383 days (range: 156-868) after relapse following PBSCT. Three patients d ied of progressive disease at a median of 284 days (range: 224-648) after p ost-PBSCT relapse. Six patients achieved a complete response, four patients had a partial response, three patients had stable disease, and six patient s had progressive disease in response to first-line salvage chemotherapy, S even patients experienced grade III/IV neutropenia, and three patients expe rienced grade III/IV thrombocytopenia, Conclusions. We conclude that in a patient population selected for chemothe rapy sensitive and low-volume disease prior to PBSCT, patients with recurre nt tumor appear to respond to salvage chemotherapy, and associated hematolo gic toxicity is acceptable and manageable. (C) 2000 Academic Press.