TY - JOUR
T1 - Randomized trial of high dose chemotherapy with autologous bone marrow support as adjuvant therapy for high-risk, multi-node positive malignant melanoma
AU - Meisenberg, Barry R.
AU - Ross, Maureen
AU - Vredenburgh, James J.
AU - Jones, Roy
AU - Shpall, E. J.
AU - Seigler, Hillard F.
AU - Coniglio, David M.
AU - Wu, Katherine
AU - Peters, William P.
N1 - Funding Information:
Supported by Public Health Service grants RO1CA-57767 and KO7CA-01604, from the National Cancer Institute, National Institutes of Health, Department of Health and Human Services; and by grant PBR67990 from the American Cancer Society.
PY - 1993/7/7
Y1 - 1993/7/7
N2 - Background: Chemotherapy adjuvant to surgery in metastatic melanoma has been evaluated in only a few prospective randomized trials. In the treatment of metastatic melanoma, dacarbazine has response rates of 15%-25%and in several studies, when combined with other alkylating agents, has yielded even higher response rates. Among the highest response rates are those achieved by using high-dose chemotherapy regimens combined with autologous bone marrow support (transplantation). Purpose: We conducted a prospective randomized clinical trial to test that efficacy of high-dose alkylating agents in combination with autologous bone marrow support given as adjuvant therapy for high-risk stage II (World Health Organization) melanoma. Methods: Thirty-nine patients with metastases involving five or more lymph nodes were randomly assigned to one of two treatment arms within 8 weeks of lymphadenectomy: immediate treatment or observation only. The immediate-treatment arm consisted of 19 patients who, immediately after random assignment. received high-dose chemotherapy with alkylating agents, followed 3 days later by reinfusion of autologous bone marrow. The observation arm consisted of 20 patients who were observed until relapse (confirmed by biopsy) and were then treated with the identical high-dose alkylating agent chemotherapy followed by reinfusion of autologous bone marrow. Bone marrow was harvested from the patients under general anesthesia 1-2 weeks prior to chemotherapy and was cryopreserved. Chemotherapy consisted of intravenous administration of cyclophosphamide (1875 mg/m2 as a 1hour infusion daily for 3 days), cisplatin (55 mg/m2 per day by continuous infusion over the same 72 hour period) and carmustine (BCNU) (600 mg/m2) given immediately after cisplatin on the 4th day as a 2-hour infusion. The total doses of the three drugs were 5625, 165, and 600 mg/m2, respectively. All patients received medical evaluations every 6-12 weeks over the study period. Kaplan-Meier estimates were used to determine the time to disease progression on the basis of intent to treat. Results: There was no statistically significant difference in overall survival or in time to disease progression between the two treatment arms. However, the median time to progression was 16 weeks in the observation arm and 35 weeks in the immediate-treatment arm. Conclusions: Immediate adjuvant highdose chemotherapy with alkylating agents followed by autologous bone marrow support more than doubled the time to disease progression compared with observation alone, though the difference was not statistically significant. No differences in overall survival were noted.[J Natl Cancer Inst 85: 1080-1085, 1993].
AB - Background: Chemotherapy adjuvant to surgery in metastatic melanoma has been evaluated in only a few prospective randomized trials. In the treatment of metastatic melanoma, dacarbazine has response rates of 15%-25%and in several studies, when combined with other alkylating agents, has yielded even higher response rates. Among the highest response rates are those achieved by using high-dose chemotherapy regimens combined with autologous bone marrow support (transplantation). Purpose: We conducted a prospective randomized clinical trial to test that efficacy of high-dose alkylating agents in combination with autologous bone marrow support given as adjuvant therapy for high-risk stage II (World Health Organization) melanoma. Methods: Thirty-nine patients with metastases involving five or more lymph nodes were randomly assigned to one of two treatment arms within 8 weeks of lymphadenectomy: immediate treatment or observation only. The immediate-treatment arm consisted of 19 patients who, immediately after random assignment. received high-dose chemotherapy with alkylating agents, followed 3 days later by reinfusion of autologous bone marrow. The observation arm consisted of 20 patients who were observed until relapse (confirmed by biopsy) and were then treated with the identical high-dose alkylating agent chemotherapy followed by reinfusion of autologous bone marrow. Bone marrow was harvested from the patients under general anesthesia 1-2 weeks prior to chemotherapy and was cryopreserved. Chemotherapy consisted of intravenous administration of cyclophosphamide (1875 mg/m2 as a 1hour infusion daily for 3 days), cisplatin (55 mg/m2 per day by continuous infusion over the same 72 hour period) and carmustine (BCNU) (600 mg/m2) given immediately after cisplatin on the 4th day as a 2-hour infusion. The total doses of the three drugs were 5625, 165, and 600 mg/m2, respectively. All patients received medical evaluations every 6-12 weeks over the study period. Kaplan-Meier estimates were used to determine the time to disease progression on the basis of intent to treat. Results: There was no statistically significant difference in overall survival or in time to disease progression between the two treatment arms. However, the median time to progression was 16 weeks in the observation arm and 35 weeks in the immediate-treatment arm. Conclusions: Immediate adjuvant highdose chemotherapy with alkylating agents followed by autologous bone marrow support more than doubled the time to disease progression compared with observation alone, though the difference was not statistically significant. No differences in overall survival were noted.[J Natl Cancer Inst 85: 1080-1085, 1993].
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U2 - 10.1093/jnci/85.13.1080
DO - 10.1093/jnci/85.13.1080
M3 - Article
C2 - 8515495
AN - SCOPUS:0027159520
SN - 0027-8874
VL - 85
SP - 1080
EP - 1085
JO - Journal of the National Cancer Institute
JF - Journal of the National Cancer Institute
IS - 13
ER -