High-dose thiotepa with autologous bone marrow transplantation for metastatic malignant melanoma: results of phase I and II studies of the North American Bone Marrow Transplantation Group.

Abstract

We evaluated thiotepa in escalating dose in a broad phase I and II study using cryopreserved autologous bone marrow transplantation to assure hematopoietic recovery. Thiotepa was administered intravenously (IV) over two hours daily for three consecutive days followed in three to four days by marrow transplantation. The daily dose ranged from 60 to 525 mg/m2 (total dose, 180 to 1,575 mg/m2). A total of 71 patients with malignant melanoma were treated. Forty-three patients (61%) had received prior cytotoxic therapy and 28 were untreated. Sixty-two patients (87%) had melanoma disseminated to at least one visceral site, nine patients had skin and/or lymphatic metastases only. As of January 1, 1988 one patient was too early to be evaluated, 15 patients were inevaluable for tumor response, four patients had a complete response (CR), and 25 patients had a partial response (PR) to treatment. The response rates (95% confidence interval) for the 55 evaluable patients and for all 71 treated patients were 53% (40% to 65%) and 41% (30% to 53%), respectively. The median duration of response was 3 months, with a range of 1 to 31 + months. Three patients were alive and well without evidence of tumor more than 1 year after treatment. Analysis of patient subsets indicated that neither total dose, previous cytotoxic therapy, or sites of metastases influenced response rate. In this study, high-dose thiotepa has demonstrated a high response rate in patients with metastatic malignant melanoma with both PRs and CRs noted. Although most of the responses were not durable, 10% of the responses lasted more than 1 year. Future studies will evaluate additional methods for increasing the response rate and improving the duration of response.

High Dose Chemotherapy with Thiotepa, Mitoxantrone and Carboplatin (TMJ) Followed by Autologous Stem Cell Support in 100 Consecutive Lymphoma Patients in a Single Centre: Analysis of Efficacy, Toxicity and Prognostic Factors

“…Owing to its apparent benefit as a single agent against breast cancer in early NSABP adjuvant therapy trials [25] and its almost 20-fold increase potential for HDCT with Hematopoitic stem cell transplant (HSCT) [26,27] thiotepa became an integral component of many HDCT regimens [28,29].…”

Marrow Storage Techniques: A Clinical Comparison of Refrigeration versus Cryopreservation

“…The cyclophosphamide, carmustine and etoposide (CBV) regimen initially reported by Spitzer et al [27] has somewhat lower doses than the BCNU, etoposide and cyclophosphamide regimens that we used and has been employed as a preparative regimen for allogeneic transplantation [28]. Highdose cyclophosphamide with total body irradiation [29] or ThioTEPA 900 mg/m2 are considered to be myeloablative [15,30] and were used safely in this cur rent study with refrigeration storage of bone marrow.…”

Non‐endocrine late complications of bone marrow transplantation in childhood: part I

“…They are normally classified as due to CNS infections, metabolic encephalopathies or thrombotic and haemorraghic cerebrovascular events. Also, they may be related to neurotoxicity of drugs used in the conditioning regimens (Sureda et al , 1989; Wolff et al , 1989), to immunosuppressives, such as cyclosporine (Reece et al , 1991) and steroids (Patchell, 1994), or to antimicrobials and antifungals for the treatment of infections (Pavletic et al , 1996).…”