High-dose chemotherapy with autologous peripheral stem cell support in advanced ovarian cancer.
High-dose chemotherapy with autologous peripheral stem cell support in advanced ovarian cancer.
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高剂量化疗与自体外周干细胞支持治疗晚期卵巢癌。
DOI：
10.3109/07853899509031949
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发表时间：
1995
影响因子：
4.4
通讯作者：
S. Mancuso
中科院分区：
文献类型：
--
作者：
P. Benedetti‐Panici;S. Greggi;G. Scambia;M. Salerno;G. Menichella;L. Pierelli;M. Foddai;B. Bizzi;S. Mancuso
20例晚期（III-IV期），先前未经治疗的卵巢癌通过以下方式治疗：（a）诱导化疗（40 mg/m2顺铂，第1-4天; 1.5 g/m2环磷酰胺，第4天;每4周一次，共2个周期），随后是（B）强化化疗（100 mg/m2顺铂，第1天; 650 mg/m2依托泊苷，第2天; 1.8 g/m2卡铂，第3天）。资格标准进一步包括：年龄小于55岁，中等好到差的肿瘤等级，肉眼可见（> 0.5cm）的残留肿瘤。在诱导周期后招募自体外周干细胞，为了确保血液学支持，在前14例中常规进行自体骨髓收获。血液学支持包括16例自体外周干细胞和4例自体骨髓移植。所有患者的毒性均可评估，19例患者的病理反应可评估，其中1例患者在自体骨髓移植后35天死于全身性真菌病。重度血液学外毒性如下：胃肠道（100%）、神经系统（10%）、肝脏（10%）。84%的病例检测到病理学反应（CR 37%，显微镜PR 26%，肉眼PR 21%）。从入组和二次随访开始，中位随访时间分别为48个月和41个月。四年总体生存率为62%，无进展生存率为57%。10名NED患者仍然存活（7名患者中有6名CR，5名患者中有3名显微镜PR，4名患者中有1名肉眼PR）。与自体骨髓移植相比，自体外周干细胞移植显著缩短了再生障碍性贫血的持续时间，并且在接受自体外周干细胞移植的患者中，毒性被证明是可控的。在显示CR和显微镜PR的患者中延长的无病生存期表明，值得对这种新方法进行进一步研究。
Twenty patients with advanced (stage III-IV), previously untreated ovarian carcinoma were treated by: (a) induction chemotherapy (40 mg/m2 cisplatin, days 1-4; 1.5 g/m2 cyclophosphamide, day 4; every 4 weeks for two cycles) followed by (b) intensification chemotherapy (100 mg/m2 cisplatin, day 1; 650 mg/m2 etoposide, day 2; 1.8 g/m2 carboplatin, day 3). Eligibility criteria further included: age less than 55 years, moderately good to poor tumour grade, macroscopic (> 0.5 cm) residual tumour. Autologous peripheral stem cells were recruited after the induction cycles and, to ensure haematological support, autologous bone marrow harvesting was routinely performed in the first 14 cases. Haematological support consisted of autologous peripheral stem cells and autologous bone marrow transplant in 16 and four patients, respectively. All patients are evaluable for toxicity and 19 for pathological response, one being dead of systemic mycosis 35 days after the autologous bone marrow transplant. Severe extra-haematological toxicities were the following: gastrointestinal (100%), neurological (10%), hepatic (10%). Pathological response was detected in 84% of cases (CR 37%, microscopic PR 26%, macroscopic PR 21%). Median follow-up times of 48 and 41 months have been reached respectively from enrolment and second-look. Four-year 62% overall and 57% progression-free survivals have been reached. Ten patients are still alive with NED (six of seven with CR, three of five with microscopic PR, and one of four with macroscopic PR). Autologous peripheral stem cell transplant significantly reduced the duration of aplasia compared with autologous bone marrow transplant, and toxicity was proved to be manageable in those patients undergoing autologous peripheral stem cell transplant. The prolonged disease-free survival in patients showing CR and microscopic PR suggests that further investigation on this new approach is worthwhile.