Evaluation of pre-radiotherapy cyclophosphamide in patients with newly diagnosed glioblastoma multiforme

Cyclophosphamide is an alkylating agent that has shown activity in the trea tment of pediatric brain tumors, including high-grade gliomas. This study w as designed to evaluate the response of patients with newly diagnosed gliob lastoma multiforme to pre-radiotherapy cyclophosphamide. Fourteen patients with glioblastoma multiforme were treated with high-dose cyclophosphamide ( 2 g/m(2)/day for 2 doses every 28 days) followed by either sargramostim or filgrastin. Sargramostim was given 250 mu g/m(2) subcutaneously twice a day continuing through the leukocyte nadir until the absolute neutrophil count was more than 1000 cells/mu l for 2 consecutive days. The filgrastin dose was 10 mu g/kg given subcutaneously once daily until the post nadir absolut e neutrophil count was greater than or equal to 10,000 cells/mu l. A total of 46 courses was given. Four patients received a total of 3 courses, 7 pat ients completed 4 courses and 3 patients received 2 courses. Three patients demonstrated complete response; 3 stable disease; and 8 progressive diseas e. The most common toxicity was hematologic, requiring platelet and packed red blood cell transfusions, with 13 admissions for neutropenia with fever. There were no deaths related to infection or bleeding. These results sugge st that high-dose cyclophosphamide has modest activity with acceptable toxi city against newly diagnosed glioblastoma multiforme.