Abstract
Purpose: Anaplastic oligodendroglioma is a chemosensitive glial neoplasm. To improve disease control and postpone cranial radiotherapy, we designed a phase II study of intensive procarbazine, lomunstine and vincristine followed by high-dose thiotepa with autologous stem cell rescue for patients with newly diagnosed anaplastic or aggressive oligodendroglioma.
Patients and methods: Sixty-nine patients with a median age of 42 (range: 18–67) and a median Karnofsky Performance Score of 90 (range: 70–100) were enrolled. Sixteen patients had a prior diagnosis of low-grade oligodendroglioma and 16 had mixed oligoastrocytoma pathology. Only patients with demonstrably chemosensitive enhancing tumors or those free of enhancing tumor after surgery and induction therapy were eligible to receive high-dose thiotepa.
Results: Thirty-nine patients (57%) completed the transplant regimen; their estimated median progression-free survival is 69 months and median overall survival has not been reached. Twelve transplanted patients (31%) relapsed. Neither histology nor prior low-grade oligodendroglioma correlated with relapse; however, persistent non-enhancing tumor at transplant conferred an increased risk of relapse (p = 0.028). The transplant regimen was well-tolerated; median hospital stay was 20 days (range: 7–43) with a median time to ANC and platelet engraftment of 10 days. Thirty patients (43%) did not receive high-dose thiotepa because of stable or progressive disease (n = 21), excessive toxicity (n = 4), refusal of further therapy (n = 2), failure to obtain insurance coverage (n = 2), or other (n = 1). No treatment-related or long-term neurotoxicity was seen in the transplanted patients.
Conclusions: High-dose chemotherapy with stem cell rescue as initial treatment for anaplastic oligodendroglioma is feasible and associated with prolonged tumor control in some patients.
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References
Cairncross JG, Macdonald DR, Ludwin S, Lee D, Cascino T, Buckner J, Fulton D, Dropcho E, Stewart D, Schold C Jr, Wainman N, Eisenhauer E: Chemotherapy for anaplastic oligodendroglioma. J Clin Oncol 12: 2013–2021, 1994
Cairncross JG, Macdonald DR: Chemotherapy for oligodendroglioma. Arch Neurol 48: 225–227, 1991 134
Chamberlain MC, Kormanik PA: Salvage chemotherapy with paclitaxel for recurrent oligodendrogliomas. J Clin Oncol 15: 3427–3432, 1997
Friedman HS, Lovell S, Rasheed K, Friedman AH: Treatment of adults with progressive oligodendroglioma with carboplatin (CBDCA): preliminary results. Med Ped Oncol 31: 16–18, 1998
Mason WP, Krol GS, De Angelis LM: Low-grade oligodendroglioma responds to chemotherapy. Neurology 46: 203–207, 1996
Kim L, Hochberg FH, Thornton AF, Harsh GR, Patel H, Finkelstein D, Louis DN: Procarbazine, lomustine, and vincristine (PCV) chemotherapy for grade III and grade IV oligoastrocytomas. J Neurosurg 85: 602–607, 1996
Peterson K, Paleologos NA, Forsyth P, Macdonald DR, Cairncross JG: Salvage chemotherapy for oligodendrogliomas. J Neurosurg 85: 597–601, 1996
Gannett DE, Wisbeck WM, Silbergeld DL, Berger MS: The role of postoperative irradiation in the treatment of oligodendroglioma. Int J Radiat Oncol Biol Phys 30: 567–573, 1994
Gehan EA: The determination of the number of patients required in a preliminary and a follow-up trial of a new chemotherapeutic agent. J Chron Dis 13: 353, 1961
Kaplan EL, Meier P: Non-parametric estimation from incomplete observations. J Am Stat Assoc 53: 457–481, 1958
Smith JS, Perry A, Borell TJ, Lee HK, O'Fallon J, Hosek SM, Kimmel D, Yates A, Burger PC, Scheithauer BW, Jenkins RB: Alterations of chromosome arms 1p and 19q as predictors of survival in oligodendroglioma, astrocytomas, and mixed oligoastrocytomas. J Clin Oncol 18: 636–645, 2000
Cairncross JG, Ueki K, Zlatescu MC, Lisle DK, Finkelstein DM, Hammond RR, Silver JS, Stark PC, Macdonald DR, Ino Y, Ramsay DA, Louis DN: Specific genetic predictors of chemotherapeutic response and survival in patients with anaplastic oligodendrogliomas. J Natl Cancer Inst 90: 1473–1479, 1998
Ino Y, Betensky RA, Zlatesco MC, Sasaki H, Macdonald DR, Stemmer-Rachamimov AO, Ramsay DA, Cairncross JG, Louis DN: Molecular subtypes of anaplastic oligodendroglioma: implications for patient management at diagnosis. Clin Cancer Res 7: 839–845, 2001
Kraus JA, Koopmann J, Kaskel P, Maintz D, Brandner S, Schramm J, Louis DN, Wiestler OD, von Deimling A: Shared allelic losses on chromosomes 1p and 19q suggest a common origin of oligodendroglioma and oligoastrocytoma. J Neuropathol Exp Neurol 54: 91–95, 1995
Mork SJ, Lindegaard K, Halvorsen TB, Lehmann EH, Solgaard T, Hatlevoll R, Harvei S, Ganz J: Oligodendroglioma: incidence and biological behavior in a defined population. J Neurosurg 63: 881–889, 1985
Paleologos NA, Macdonald DR, Vick NA, Cairncross JG: Neoadjuvant procarbazine, CCNU, and vincristine for anaplastic and aggressive oligodendroglioma. Neurology 53: 1141–1143, 1999
Cairncross JG, Swinnen L, Bayer R, Rosenfeld S, Vaughan W, Paleologos N, Kaminer L, Forsyth P, Stewart D, Macdonald D, Ramsay D, Smith A: Myeloablative chemotherapy for recurrent aggressive oligodendroglioma. Neuro-Oncology 2: 114–119, 2000
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Abrey, L.E., Childs, B.H., Paleologos, N. et al. High-dose Chemotherapy with Stem Cell Rescue as Initial Therapy for Anaplastic Oligodendroglioma. J Neurooncol 65, 127–134 (2003). https://doi.org/10.1023/B:NEON.0000003645.82791.2a
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DOI: https://doi.org/10.1023/B:NEON.0000003645.82791.2a