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Sarcoma
Volume 8, Issue 2-3, Pages 63-69
http://dx.doi.org/10.1155/2004/329273

High-Dose Chemotherapy Followed by Peripheral and/or Bone Marrow Stem Cell Transplant in Patients With Advanced Sarcoma: Experience of a Canadian Centre

1Department of Medicine, McMaster University and Division of Medical Oncology, Hamilton Regional Cancer Centre (HRCC), 699 Concession Street, Hamilton, Ontario L8V 5C2, Canada
2Department of Oncology, Queen's University and Division of Medical Oncology, Kingston Regional Cancer Centre (KRCC), Kingston, Ontario, Canada
3Department of Medicine, University of Western Ontario, Division of Medical Oncology, LRCC and Division of Hematology, London Health Science Centre, London, Ontario, Canada

Copyright © 2004 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose: Few reports have been published on the evaluation of stem cell auto transplantation for chemosensitive sarcomas. Some suggest benefit, others do not. We present results of 24 patients with sarcoma undergoing autotransplantation at a Canadian institution.

Patients and Methods: Twenty-four patients were treated between 1988 and 1998: 23 were ≥18 years (median 27; range 12–56); genders were equal; 12 patients had Ewing's sarcoma. At diagnosis, 12 (50%) had metastatic disease. Prior to autotransplant, all had ≥1 chemotherapy regimen. Fourteen (58%) were in complete remission (CR) and seven (29%) had minimal residual disease. All received etoposide 60 mg/kg (Day –4), melphalan 140 mg/m2 on (Day –3) and a stem cell reinfusion (Day 0).

Results: Three patients (12.5%) were alive and disease-free with median follow-up of 92 months (80–142); one was alive with disease 32 months post-autotransplant. Twenty had died (disease, 17; transplant-related, 2; unknown, 1). Of the four alive, three had Ewing's sarcoma, one alveolar rhabdomyosarcoma, and all were in CR at transplant. Median time to relapse was 6 months (2–59). Sixteen of 18 (89%) relapsed within 1 year. Median overall survival was 10 months (0–137). A trend towards improved survival (P=0.07) was evident for patients in CR prior to autotransplant.

Conclusions: Stem cell autotransplantation does not benefit most patients with sarcoma. A subgroup of high-risk patients in CR may fare better and warrant further study.