The prognostic importance of myelosuppression in the response to chemotherapy and survival in advanced ovarian carcinoma.
Fifty-three patients treated between 1974 and 1981 were analyzed to establish the relationship between myelosuppression, tumor response, and survival in the treatment of advanced ovarian carcinoma, Stage III-IV, with melphalan alone or a melphalan-doxorubicin combination. The total response rate was 34% and the 5-year survival rate was 24.5%. Responders had significantly higher performance status and hemoglobin values at the start of chemotherapy. During chemotherapy the mean nadir values of leukocytes and thrombocytes were identical for responders and nonresponders and the degree of myelosuppression measured in this way did not predict the probability of tumor response or survival. The bone marrow of nonresponders seemed to be more active, judging from a tendency towards higher leukocyte and thrombocyte cell counts before the individual chemotherapy courses than in responders. Dose reduction and interval prolongation seemed to worsen the prognosis with regard to tumor response and long-term survival. Combination chemotherapy with melphalan-doxorubicin was superior to single drug therapy with melphalan with regard to bone marrow toxicity, tumor response rate and survival. The most important single prognostic factor at the start of chemotherapy was the performance status (Karnofsky's index). Myelosuppression per se did not improve the prognosis with regard to tumor response or survival in this series.
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D001772:Blood Cell Count; D001792:Blood Platelets; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D007958:Leukocyte Count; D008558:Melphalan / Q000008:administration & dosage; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000401:mortality; D011379:Prognosis
D000970:Antineoplastic Agents; D006454:Hemoglobins; D004317:Doxorubicin; D008558:Melphalan