Bruce D. Cheson, MD; Leocadio Lacerna, MD; Brian Leyland-Jones, MD; Gisele Sarosy, MD; Robert E. Wittes, MD
Purpose: To assess the current status of high-dose chemotherapy with autologous marrow transplantation in hematologic malignancies and solid tumors.
Data Identification: Studies reported between 1978 and May 1988 were identified through computer searches using Medline and Cancerline and through extensive manual searching of bibliographies of identified books and articles.
Study Selection: More than 160 studies that contained adequate response, toxicity, or survival data were selected for analysis, including peer-reviewed articles, book chapters, and proceedings of meetings. The most current or complete references were used for series reported more than once.
Data Analysis: Information abstracted included regimen used, number of patients, response rates, disease-free and overall survival, and toxicities. A meta-analysis of the pooled data was done.
Results of Data Analysis: For many tumor types, autologous marrow transplantation offers higher response rates than standard approaches. For leukemias and lymphomas, response rates of 60% to 80% may be achieved with the potential for cure. With solid tumors, response rates range from 30% in gliomas, 50% in melanomas and colon cancer, more than 60% in lung cancer, and 80% in breast cancer. Although responses tend to be short-lived, long-term survival can occasionally be seen.
Conclusions: Results with autologous marrow transplantation can be improved through systematically developed, carefully designed clinical trials that may be facilitated by collaborative research. Studies should focus on disease-directed drug combinations, several courses of high-dose therapy, treatment at a time of lower tumor burden, and reducing toxicity with hematopoietic growth factors.
Bruce D. Cheson, Leocadio Lacerna, Brian Leyland-Jones, Gisele Sarosy, Robert E. Wittes. Autologous Bone Marrow Transplantation: Current Status and Future Directions. Ann Intern Med. 1989;110:51–65. doi: 10.7326/0003-4819-110-1-51
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Published: Ann Intern Med. 1989;110(1):51-65.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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