Treatment of disseminated melanoma by systemic melphalan, methotrexate and autogenous bone marrow transplants.Experience with 114 patients

Abstract

One hundred fourteen patients suffering from disseminated melanoma were treated by combined chemotherapy—phenylalanine mustard (melphalan) and methotrexate plus autogenous bone marrow transfusion. Of these, 28 remain alive and 86 have died; 2 patients were lost to follow-up and are presumed dead. Three post-treatment deaths occurred. Thirteen patients enjoyed longevity from 12 to 50 months before their demise from disseminated melanoma. Symptomatic response was noted in 68.0% of the patients; relief of pain in 32 patients (35.5%), a sense of well-being in 45 (56.2%), and relief of respiratory symptoms in 18 (54.5%). Objective evidence of response included decrease of hepatomegalia, temporary decrease and/or disappearance of cutaneous and subcutaneous nodules and shrinkage of metastases in the lymph nodes and lung. The major complication was leucopenia, observed in 63.0%; in 17 patients the white blood count dropped to a level below 1,000 cells/mm3 and rehospitalization was necessary in 25 patients for treatment. Although the hazards to the patient may be increased by the addition of methotrexate to a course of phenylalanine mustard plus autogenous marrow transfusion in the treatment of disseminated melanoma, this triple regimen appears to complement and augment the improvement which occurred as evidenced in the significant subjective and objective responses, however slight, short-lived and transitory.