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High-dose chemotherapy with stem cell rescue as initial therapy for anaplastic oligodendroglioma: Long-term follow-up

Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA (L.E.A., B.H.C., S.D.N., L.M.D.); Northwestern University, Evanston, IL 60201, USA (N.P., L.K.); University of Alabama, Birmingham, AL 35294, USA (S.R., D.S.); New York University, New York, NY 10016, USA (J.L.F., S.G.); Stanford University Medical Center, Stanford, CA 94305, USA (K.P., W.H.); Loyola University Medical Center, Maywood, IL 60153, USA (L.S., R.B.); University of Calgary, Calgary, AB, T2N 1N4, Canada (P.F., D.S.); Kingston Regional Cancer Centre, Kingston, ON, K7L 5P9, Canada (A.M.S.); London Regional Cancer Centre, London, ON N6A 4L6, Canada (D.R.M., D.A.R., J.G.C.); and Albany Medical College, Albany, NY 12208, USA (S.W.)

¹ Address correspondence to Lauren Abrey, Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021 (abreyl{at}mskcc.org).

We previously reported a phase 2 trial of 69 patients with newly diagnosed anaplastic or aggressive oligodendroglioma who were treated with intensive procarbazine, CCNU (lomustine), and vincristine (PCV) followed by high-dose thiotepa with autologous stem cell rescue. This report summarizes the long-term follow-up of the cohort of 39 patients who received high-dose thiotepa with autologous stem cell support. Thirty-nine patients with a median age of 43 (range, 18-67) and a median KPS of 100 (range, 70-100) were treated. Surviving patients now have a median follow-up of 80.5 months (range, 44-142). The median progression-free survival is 78 months, and median overall survival has not been reached. Eighteen patients (46%) have relapsed. Neither histology nor prior low-grade oligodendroglioma correlated with risk of relapse. Persistent nonenhancing tumor at transplant was identified in our initial report as a significant risk factor for relapse; however, long-term follow-up has not confirmed this finding. Long-term neurotoxicity has developed only in those patients whose disease relapsed and required additional therapy; no patient in continuous remission has developed a delayed neurologic injury. This treatment strategy affords long-term disease control to a subset of patients with newly diagnosed anaplastic oligodendroglioma without evidence of delayed neurotoxicity or myelodysplasia.

Key Words: anaplastic • chemotherapy • oligodendroglioma