Tandem high-dose chemotherapy followed by autologous transplantation in patients with locally advanced or metastatic sarcoma.

BACKGROUND: Patients with locally advanced or metastatic/recurrent soft tissue and Ewing's sarcoma (EWS) have few treatment options. The purpose of our phase II study was to assess the feasibility, safety and efficacy of tandem high-dose chemotherapy (HDCT) followed by autologous stem cell transplantation (ASCT) in such patients. PATIENTS AND METHODS: Thirteen patients were enrolled onto this study. The first cycle of HDCT consisted of doxorubicin (150 mg/m(2)) and ifosfamide (14 g/m(2)) mixed with mesna (14 g/m(2)), while the second cycle consisted of melphalan (150 mg/m(2)) and cisplatin (200 mg/m(2)). RESULTS: Eleven out of 13 patients were able to complete both cycles of HDCT. No treatment-related mortality occurred and grade 3 or 4 toxicity was clinically tolerable. The 5-year progression-free survival (PFS) and overall survival (OS) for all patients was 23% (confidence interval, CI: 0-46%) and 31% (CI: 14-70%), respectively. Out of the four patients still alive, two had EWS and measurable disease at the time of ASCT and achieved a complete remission, remaining progression free 126 and 155 months after ASCT. CONCLUSION: Our study demonstrates the feasibility and safety of tandem HDCT in patients with high-risk or metastatic/recurrent sarcoma, with some patients achieving long-term PFS and OS.

Long-term outcome of autologous transplantation of peripheral blood progenitor cells as postremission management of patients > or =60 years with acute myelogenous leukemia.

The optimal postremission treatment for elderly patients with acute myelogenous leukemia (AML) is presently unknown, but recent studies report the feasibility of autologous stem cell transplantation in this population. To better understand the long-term outcome of autologous transplantation in AML patients > or =60 years of age, we evaluated high-dose chemoradiotherapy preparative conditioning followed by transplantation of peripheral blood progenitor cells procured after a single cycle of cytarabine-based consolidation chemotherapy as postremission therapy in 27 patients aged 60 to 71 years (median age, 65 years) with newly diagnosed AML in first complete remission (CR). The median follow-up from CR for all patients was 13.6 months (range, 6.0-123.1 months). The median follow-up from remission for surviving patients was 81 months (range, 41.4-123.1 months). Seven patients are alive in continuous CR, 19 died from relapse, and 1 died as a result of treatment-related infection. Leukemia-free survival and overall survival are 10.3 and 13.4 months, respectively. Actuarial leukemia-free and overall survival at 3 years are 25% +/- 9% and 28% +/- 9%, respectively. Our results demonstrate that autologous transplantation of peripheral blood progenitor cells is well tolerated and feasible for patients > or =60 years of age with AML in first CR. Future investigation should focus on a randomized study evaluating a larger group of elderly patients in first CR comparing autologous stem cell transplantation with conventional cytarabine-based consolidation chemotherapy to identify the optimal postremission therapy.

Effect of pelvic lymph node irradiation in salvage therapy for patients with prostate cancer with a biochemical relapse following radical prostatectomy.

Radiation therapy (RT) as salvage treatment for a biochemical relapse following prostatectomy has been shown to be of benefit measured by serum prostate-specific antigen (PSA) control. However, identifying a target volume for RT has not been well established in this setting. In this study, the results of postoperative RT delivered to extended fields (EFs), prostatic fossa, and pelvic lymph nodes encompassing at least the obturator lymph nodes are compared with treatment of limited fields (LFs), prostatic fossa only, as salvage treatment for patients with a biochemical relapse. Between 1987 and 1999, 68 patients were referred for postprostatectomy RT. Of these patients, 46 were treated for salvage intent by RT alone without adjuvant hormones, 21 patients were treated to EFs and 25 treated to LFs. All patients were treated using 4-field plans. The mean field sizes measured 15 x 14 cm (AP/PA fields) and 12 x 14 cm LFs for the EFs and 10 x 10 cm (AP/PA fields) and 10 x 10 cm (lateral fields) for the LFs. The mean total doses for the EFs and LFs were 6300 and 6200 cGy, respectively, using 180-cGy daily increments. All patients treated to the EFs received boost doses to the prostatic fossa after 4500 cGy total dose to the pelvis. The 10-year actuarial biochemical disease-free survival (DFS) rates for the EF and LF groups were 52% and 47%, respectively (P = 0.523). The distant metastasis-free survival (DMFS) rates were 77% and 78% (P = 0.925), and overall survival (OS) rates were 88% and 68% (P = 0.615) for the EF and LF group, respectively. A subset analysis of patients with adverse pathologic features (including tumor-involved surgical margins, lymph node involvement, seminal vesicle involvement, extracapsular extension, and/or perineural invasion) showed biochemical DFS rates of 57% and 44% (P = 0.217) for the EF and LF groups, respectively. The DMFS rates were 84% and 72% (P = 0.423), and OS rates 92% and 61% (P = 0.366) for the EF and LF groups, respectively. For patients with increasing PSA levels after a radical prostatectomy, salvage irradiation is a viable option for biochemical control. Our results suggest that EF radiation with coverage of pelvic lymph nodes shows a trend toward better PSA control in those with adverse pathologic features, although statistical significance was not achieved because of the limited number of patients who satisfied the restricted criteria excluding use of adjuvant hormones.