title: Does high-dose carmustine increase overall survival in supratentorial high-grade malignant glioma? An EBMT retrospective study.
abstract: Radiotherapy plus concomitant and adjuvant temozolomide have demonstrated improved survival for glioblastoma. However, prognosis remains poor. High-doses chemotherapy with carmustine is another way to improve response and survival by increasing the dose delivered. Myelotoxicity imposes autologous stem cell rescue. European Group for Blood and Marrow Transplantation experience of this treatment in patients with high-grade glioma was reported here. A retrospective analysis of 217 patients from European Group for Blood and Marrow Transplantation database was realized. Ninety-six patients underwent complete surgical resection while the 121 others had partial resection or only biopsy and were evaluable for an antitumor effect. Patients received 800 mg/m2 of carmustine intravenously at least 1 month after neurosurgery. Forty-eight to 72 hr after chemotherapy, 108 patients received autologous hematopoietic stem cells from bone marrow harvest and 109 patients autologous hematopoietic stem cells from peripheral blood. Radiotherapy was started approximately 40 days after transplantation. Ten deaths were related to the treatment. Of the 121 patients evaluable for tumor response, 64 (53%) presented an objective response. This protocol appear feasible, but with toxicity-related mortality of 4.5%. Median overall survival was 20 months and median time to treatment failure was 7 months. Overall survival and time to treatment were correlated with age, quality of resection and histological subtypes. In glioblastoma multiforme, age and surgery quality appeared to be prognostic factors. Compared with Stupp et al.'s recent study, this study did not favor high-dose carmustine for patients with glioblastoma multiforme with complete surgical resection.
authors.affiliation: Unité de transplantation médullaire et département de radiothérapie, Centre Jean Perrin, Clermont-Ferrand, France. olivier.bay@cjp.fr
authors.forename: Jacques-Olivier
authors.initials: JO
authors.lastname: Bay
authors.forename: Bay
authors.initials: B
authors.lastname: Jacques-Olivier
authors.forename: Claude
authors.initials: C
authors.lastname: Linassier
authors.forename: Linassier
authors.initials: L
authors.lastname: Claude
authors.forename: Pierre
authors.initials: P
authors.lastname: Biron
authors.forename: Biron
authors.initials: B
authors.lastname: Pierre
authors.forename: Xavier
authors.initials: X
authors.lastname: Durando
authors.forename: Durando
authors.initials: D
authors.lastname: Xavier
authors.forename: Pierre
authors.initials: P
authors.lastname: Verrelle
authors.forename: Verrelle
authors.initials: V
authors.lastname: Pierre
authors.forename: Fabrice
authors.initials: F
authors.lastname: Kwiatkowski
authors.forename: Kwiatkowski
authors.initials: K
authors.lastname: Fabrice
authors.forename: Giovanni
authors.initials: G
authors.lastname: Rosti
authors.forename: Rosti
authors.initials: R
authors.lastname: Giovanni
authors.forename: Taner
authors.initials: T
authors.lastname: Demirer
authors.forename: Demirer
authors.initials: D
authors.lastname: Taner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage*; D002330:Carmustine / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D005260:Female; D005909:Glioblastoma / Q000401:mortality* / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009837:Oligodendroglioma / Q000628:therapy; D011379:Prognosis; D012189:Retrospective Studies; D015173:Supratentorial Neoplasms / Q000401:mortality* / Q000628:therapy; D015996:Survival Rate; D014182:Transplantation, Autologous
chemical_list: D018906:Antineoplastic Agents, Alkylating; D002330:Carmustine