Journal of Clinical Oncology, Vol 15, 1309-1317, Copyright © 1997 by American Society of Clinical Oncology
High-dose chemotherapy with autologous transplantation for persistent/relapsed ovarian cancer: a multivariate analysis of survival for 100 consecutively treated patients
PJ Stiff, R Bayer, C Kerger, RK Potkul, D Malhotra, DJ Peace, D Smith and SG Fisher
Department of Medicine, Loyola University Medical Center, Maywood, IL 60153, USA.
PURPOSE: To examine the prognostic factors associated with prolonged
progression-free survival (PFS) and overall survival (OS) in 100
consecutively treated women undergoing autologous stem-cell transplant for
advanced ovarian cancer. PATIENTS AND METHODS: From October 1989 to
February 1996, we transplanted 100 patients with ovarian cancer following
chemotherapy with high-dose carboplatin, mitoxantrone, and cyclophosphamide
with or without cyclosporine (n = 70); melphalan and mitoxantrone with or
without paclitaxel (n = 25); or other regimens (n = 5). Their median age
was 48 years (range, 23 to 65), 70% had papillary serous histology, 72% had
grade III tumors, 66% were platinum- resistant, and 61% had > or = 1 cm
bulk. The median number of prior regimens was two (range, one to six).
Univariate and multivariate analyses were performed to examine age (< v
> or = mean), stage, initial bulk, histology, grade, response to initial
therapy, number of prior regimens, time from diagnosis to transplant,
transplant regimen, platinum sensitivity, and bulk (< v > or = 1 cm)
at transplant. RESULTS: The median PFS and OS times for the 100 patients
were 7 and 13 months. A stepwise Cox proportional hazards model identified
tumor bulk (P = .0001), and cisplatin sensitivity (P = .0249) as the best
predictors of PFS. Age (P = .0017), bulk at transplant (P = .0175), and
platinum sensitivity (P = .0330) provided the best prediction of OS. The
median PFS and OS times for the 20 patients with platinum- sensitive, <
or = 1-cm disease were 19 and 30 months. No differences in OS were seen
when chemotherapy or surgery was used to achieve a minimal disease state.
CONCLUSION: Before consideration of high-dose therapy for
recurrent/persistent advanced ovarian cancer, patients should undergo
debulking surgery or chemotherapy to achieve a minimal disease state.
Patients with platinum-resistant, bulky disease should not be transplanted.
The optimal patients for this therapy may be those with minimal disease
responsive to initial chemotherapy.
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