High-dose chemotherapy and autologous stem-cell transplantation for ovarian cancer: an autologous blood and marrow transplant registry report.
BACKGROUND
Autologous transplantation is increasingly used to treat epithelial ovarian cancer. However, it is not clear which patients may benefit.


OBJECTIVE
To determine overall and progression-free survival and factors associated with favorable outcome after autotransplantation for ovarian cancer.


METHODS
Observational cohort study.


METHODS
57 centers reporting to the Autologous Blood and Marrow Transplant Registry (ABMTR).


METHODS
421 women who received transplants between 1989 and 1996.


METHODS
High-dose chemotherapy using diverse regimens with hematopoietic stem-cell rescue.


METHODS
Primary outcomes were progression-free survival and overall survival. Multivariate analyses using Cox proportional hazards regression considered the following factors: age, Karnofsky performance score, initial stage, histologic characteristics, previous therapy, remission status, extent of disease, graft source, transplant regimen, and year of transplantation.


RESULTS
Most patients had extensive previous chemotherapy. Forty-one percent had platinum-resistant tumors, and 38% had tumors at least 1 cm in diameter. Only 34 patients (8%) received transplants as part of initial therapy. The probability of death within 100 days was 11% (95% CI, 8% to 14%). Two-year progression-free survival was 12% (CI, 9% to 16%), and 2-year overall survival was 35% (CI, 30% to 41%). Younger age, Karnofsky performance score of at least 90%, non-clear-cell disease, remission at transplantation, and platinum sensitivity were associated with better outcomes. Progression-free and overall survival were 22% (CI, 12% to 33%) and 55% (CI, 42% to 66%), respectively, for women with a high Karnofsky performance score and non-clear-cell, platinum-sensitive tumors.


CONCLUSIONS
Some subgroups of patients with ovarian cancer seem to have good outcomes after autotransplantation, although several biases may have affected these observations. Phase III trials are needed to compare such outcomes with outcomes of conventional chemotherapy.
Stiff
P J
PJ
Division of Hematology/Oncology, Loyola University Medical Center, 2160 South First Avenue, Building 112, Room 240, Maywood, IL 60153, USA.
Veum-Stone
J
J
Lazarus
H M
HM
Ayash
L
L
Edwards
J R
JR
Keating
A
A
Klein
J P
JP
Oblon
D J
DJ
Shea
T C
TC
Thomé
S
S
Horowitz
M M
MM
D000367:Age Factors; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D002277:Carcinoma / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003627:Data Interpretation, Statistical; D018450:Disease Progression; D019008:Drug Resistance, Neoplasm; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D012074:Remission Induction; D015996:Survival Rate; D014182:Transplantation, Autologous
D000970:Antineoplastic Agents