Very High Dose Chemotherapy with Autologous Bone Marrow Support in the Treatment of Small Cell Lung Cancer

¹ Guy's Hospital, London, England

A dose-response relationship does exist for some drugs and very high response rates can be achieved with intensive therapy. The majority of studies have shown that with chemotherapy alone bone marrow transplantation is seldom essential, unless very high dose nitrosoureas are included. Few studies have addressed the problems of re-infusion of tumor cells in the transfused marrow. In both relapsed disease and as a planned policy of late intensification, further responses can be achieved; however, overall only 1 study has shown a significant improvement in disease-free interval and no study has shown a survival advantage over that achieved by conventional therapy, though treatment times may be considerably shortened.

Careful review of aims is essential before further studies are undertaken and the procedures are probably only justifiable in patients who are reasonably fit reflected in their initially high performance scores. Further consideration should be given to the introduction of alternative "non cross-resistant" agents.