Prolongation of survival for high-grade XXXX with adjuvant high-dose BCNU and autologous bone marrow transplantation.

@entity1 @entity410 @entity137 @entity390 @entity548 @entity55 @entity5 @entity2063 @entity391 @entity11 @entity3600 @entity282 @entity2259 @entity293
@entity282 irradiation in the initial management of high-grade malignant @entity5 has now become standard. The addition of conventional chemotherapy to irradiation has not significantly improved median survival beyond 1 year. We treated 25 consecutive @entity1 (13 pilot @entity1 and 12 protocol @entity1 ) with histologically confirmed unresectable grade 3 or 4 @entity11 with high-dose BCNU ( @entity3600 ) followed by autologous bone marrow transplantation and whole brain irradiation. Within 3 weeks of initial surgery, each @entity1 had autologous bone marrow stored (median 2 X 10(8) nucleated cells/kg), and then received BCNU 1,050 mg/m2 intravenously (IV). Peripheral granulocytes recovered (greater than 500/microL) at a median of 19 days (range, 10 to 37 days), and platelets recovered (greater than 20,000/microL) at a median of 18 days (range, 13 to 40 days), following bone marrow infusion. @entity1 received 60 Gy whole brain irradiation when granulocytes were greater than 1,500/microL. @entity137 was well tolerated. @entity390 occurred in 19 @entity1 (76%); however, only eight @entity1 (32%) experienced @entity391 (mild in three, moderate in five). Eleven @entity1 (44%) did not require empiric antibiotics, six of whom never developed an absolute granulocyte count less than 500/microL. Three @entity1 with a poor performance status died early (one @entity410 with @entity391 and @entity2063 ; one, @entity293 (UTI) with @entity2259 ; one, @entity55 ), and one additional @entity1 who was performing well died of @entity548 . The 13 pilot @entity1 have now been followed for a median of 23 months, with a significant survival advantage compared with the 52 consecutive historical control @entity1 who received similar surgery and radiotherapy without high-dose BCNU (P = .037). The overall study group of 25 @entity1 also has a significant survival advantage when compared with the same historical control group, with a projected median survival of 26 months (P = .007). This new approach using early postoperative intensive therapy consisting of high-dose BCNU, autologous bone marrow transplantation, and whole brain irradiation appears to significantly improve survival.
