Hematological toxicity of salvage treatment after high-dose chemotherapy and conventional chemotherapy of ovarian cancer.
BACKGROUND
To compare the toxicity of salvage chemotherapy (CT) given for recurrent or progressive ovarian cancer (OC) after either high-dose chemotherapy (HDC) or conventional CT.


METHODS
HDC supported by autologous stem cell transplantation was given to ten OC patients. Seven of them were treated with salvage CT for recurrent disease and were included in this study (Group A). Seven patients with recurrent OC treated primarily with conventional CT (Group B) were matched for age (+/- 3 years), stage and histology. The hematological toxicity of treatment was graded according to the WHO criteria.


RESULTS
During salvage CT, grade 3-4 neutropenia was seen in nine out of 81 courses (11.1%) in Group A and in six out of 85 courses (7.1%) in Group B (p <0.1). The use of G-CSF was more common in Group A than in Group B, both during first-line and salvage CT. When the mobilisation courses were excluded in Group A, the use of G-CSF was more common during salvage treatment than during primary treatment (27 out of 81 vs. 16 out of 85, p < 0.05). Also, in Group B the use of G-CSF was more common during salvage CT than during primary treatment (10 out of 85 vs. 0 out of 73, p < 0.01). Grade 3-4 thrombocytopenia was seen in nine out of 81 courses (11.1%) in Group A but in none of the 85 courses (0%) in Group B (p<0.05). No platelet transfusion was needed during salvage treatment. The mean interval of courses in salvage CT was 27.7 days (range 19-71) in Group A and 27.5 days (range 18-120) in Group B (p = ns). Overall survival was 40.4 months in Group A and 33.0 months in Group B (p < 0.1).


CONCLUSIONS
Salvage treatment after HDC was well-tolerated when given with G-CSF support. Salvage chemotherapy could be carried out with the same doses and intervals both for patients treated earlier with HDC and conventional CT.
Vuento
Maarit Hannele
MH
Departments of Obstetrics and Gynecology, Turku University Central Hospital, Finland.
Salmi
Tuula Anneli
TA
Remes
Kari Juhani
KJ
Grénman
Seija Elisa
SE
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D003131:Combined Modality Therapy; D004305:Dose-Response Relationship, Drug; D005260:Female; D006402:Hematologic Diseases / Q000139:chemically induced*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000188:drug therapy*; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D016879:Salvage Therapy / Q000009:adverse effects; D016896:Treatment Outcome