Intensive chemotherapy with autologous bone marrow rescue for recurrent malignant gliomas

Eight patients, four male and four female, were treated with high dose chemotherapy followed by bone marrow transplantation. In the first two patients, high dose ACNU was used for the treatment without combination with other drugs. This showed severe side effects such as intratumorous bleeding on the 18th day of treatment in the first case and pulmonary fibrosis on the 35th day of treatment in the second case. Considering these results, we considered another treatment schedule which consisted of high dose ADM (100 mg/m2), VCR (1.5 mg/m2), CDDP (80 mg/m2 X 4) and Ex (800 mg/m2) within seven days. Six patients were treated with this schedule and the results indicated that two patients had a partial response (more than 50% reduction of tumour size measured by CT scan), one had a complete remission (no tumour detected by CT scan), two showed no change and one, progression of the lesion. The patients recovered from the suppression of bone marrow function after the bone marrow transplantation as indicated. Granulocytes and platelets in blood began to increase from 10 to 14 days after the transplantation and became normal within three weeks after this. Serial measurements of S-GOT and alkaline phosphatase revealed reversible elevation, if any, within four weeks of the treatment. The number of our cases is still small, but results showed that autologous bone marrow transplantation made high dose chemotherapy possible. The necessity for consideration of the blood-brain barrier for this treatment is also discussed.