Slease R B, Benear J B, Selby G B, Reitz C L, Hughes W L, Watkins C L, Epstein R B
University of Oklahoma Health Sciences Center, Oklahoma City 73190.
J Clin Oncol. 1988 Aug;6(8):1314-20. doi: 10.1200/JCO.1988.6.8.1314.
Twenty-six adults, ages 27 to 60, with refractory metastatic solid tumors were treated with high-dose cyclophosphamide (Cy) + carmustine (BCNU) at one of three escalating dose schedules followed by autologous bone marrow transplantation (ABMT). Toxicity was severe and dose-related, with the maximum tolerated dose for the combination determined to be Cy 160 mg/kg and BCNU 900 mg/m2. Median time to WBC recovery (greater than or equal to 1,000/microL) was 13 days post-ABMT (range, nine to 22 days) and to a platelet count of greater than or equal to 50,000/microL, 22 days (range, 13 to 83 days). Sixteen of 20 evaluable patients (80%) responded to therapy with at least 50% reduction in measurable tumor, and three patients achieved complete remission (CR). Responders included eight of nine evaluable patients with breast carcinoma, two of five with melanoma, two of two with sarcoma, and four of four with colon carcinoma. Response durations were short (median, 4 months), even for complete responders, and relapses generally occurred at sites of previous metastases. In order for this approach to have a more significant impact on overall survival, it may need to be applied earlier in the natural history of the malignancy.
26名年龄在27至60岁之间、患有难治性转移性实体瘤的成年人，按照三种递增剂量方案之一接受了大剂量环磷酰胺（Cy）+卡莫司汀（BCNU）治疗，随后进行自体骨髓移植（ABMT）。毒性严重且与剂量相关，该联合方案的最大耐受剂量确定为Cy 160 mg/kg和BCNU 900 mg/m²。白细胞恢复至≥1000/μL的中位时间为ABMT后13天（范围9至22天），血小板计数恢复至≥50000/μL的中位时间为22天（范围13至83天）。20例可评估患者中有16例（80%）对治疗有反应，可测量肿瘤至少减少50%，3例患者实现完全缓解（CR）。有反应者包括9例可评估乳腺癌患者中的8例、5例黑色素瘤患者中的2例、2例肉瘤患者中的2例以及4例结肠癌患者中的4例。反应持续时间较短（中位时间为4个月），即使是完全缓解者也是如此，复发通常发生在先前转移的部位。为了使这种方法对总生存期产生更显著的影响，可能需要在恶性肿瘤的自然病程中更早应用。
