High-dose carmustine with autologous bone marrow transplantation for the adjuvant treatment of high-grade gliomas of the central nervous system.

The long-term survival of patients with high-grade gliomas of the CNS is poor despite the use of radiation therapy and chemotherapy. In an attempt to improve the survival of such patients, we administered adjuvant chemotherapy as high-dose carmustine with autologous bone marrow transplantation. Eighteen patients, 15 with glioblastoma multiforme and three with anaplastic astrocytoma, were treated shortly after completion of standard radiation therapy. One course of carmustine was administered at a total dose of 900-1050 mg/m2 iv over 3 days followed in 3 days by the reinfusion of the previously cryopreserved bone marrow. Acute toxicity was mild, but eight patients had severe pulmonary or CNS toxicity of which four episodes of pulmonary toxicity were fatal. For all patients treated, the median survival was 17.5 months from diagnosis and the estimated probability of surviving greater than 27 months was 22% (95% confidence limits of 14%-32%). Presently, there are four long-term survivors, two with progressive tumor, one suffering from severe encephalomyelopathy, and one alive and well. Although, in this series, we have observed long-term survivors, the overall estimated probability of survival is not substantially different from conventional treatment. In addition, the 22% incidence of fatal pulmonary toxicity suggests that this treatment will not measurably add to the treatment of CNS gliomas.