High-dose melphalan-based chemotherapy and autologous stem cell transplantation after second look laparotomy in patients with chemosensitive advancedovarian carcinoma: long-term results

The importance of dose intensity has been suggested in ovarian carcinoma, W e retrospectively evaluated the long-term results of melphalan-based high-d ose chemotherapy (HDC) with hematopoietic rescue in a unicentric series of 33 patients with advanced ovarian cancer sensitive to first-line chemothera py. Before HDC, treatment with debulking surgery and platinum-based chemoth erapy was followed by second-look operation (SLO), HDC consisted of melphal an (n = 8), melphalan and cyclophosphamide (n = 9), or melphalan, etoposide and carboplatinum (n = 16), Toxicity was mainly hematological, One death o ccurred from infection during aplasia, With a median follow-up of 60 months after intensification, the 5-year progression-free survival (PFS) rate was 29% and the 5-year overall survival (OS) rate was 45%. Survival differed s ignificantly according to tumor status at SLO, Women with microscopic or ma croscopic disease at SLO, ie with a pathological partial response to first- line therapy (PPR), had survivals of 7% at 5 years, similar to other salvag e therapies. Better results were obtained in the 20 n omen with a complete pathological response (PCR) at SLO with 43% 5-year PFS (median, 51 months) and 75% 5-year OS (median not reached). In conclusion, melphalan-based HDC with hematopoietic rescue had an acceptable toxicity in patients with chemo sensitive advanced ovarian cancer. In situations of salvage therapy for pat ients in PPR, this treatment was not effective in long-term analysis. On th e contrary, long-term results were favorable in patients with PCR, suggesti ng further prospective randomized studies comparing HDC and other consolida tion treatments should be undertaken in this particular situation.