RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing
so they stop growing or die. Bone marrow or peripheral stem cell transplantation may be able
to replace immune cells that were destroyed by chemotherapy used to kill tumor cells.
PURPOSE: Phase II trial to study the effectiveness of chemotherapy followed by autologous
bone marrow or peripheral stem cell transplantation in treating patients with glioblastoma
multiforme or brain stem tumors.
OBJECTIVES: I. Estimate the overall survival, progression-free interval, and time to
progression or recurrence in patients with nondisseminated glioblastoma multiforme or
diffuse intrinsic brain stem tumors that are nonprogressive following surgery (if feasible)
and involved-field irradiation and treated with intensive chemotherapy followed by
autologous peripheral blood stem cell (PBSC) or autologous bone marrow (ABM) rescue. II.
Estimate the toxicity of myeloablative chemotherapy with thiotepa (TSPA) followed by
carboplatin (CBDCA) in these patients. III. Evaluate the pharmacokinetic interactions of
high-dose CBDCA, TSPA, and triethylenephosphoramide (a metabolite of TSPA) and any impact on
subsequent toxicity. IV. Evaluate the effectiveness of autologous stem cells in restoring
hematopoiesis following myeloablative therapy.
OUTLINE: All patients undergo bone marrow or stem cell harvest (investigator option) no
later than 12 weeks after completion of radiotherapy. The following acronyms are used: ABM
Autologous Bone Marrow CBDCA Carboplatin, NSC-241240 G-CSF Granulocyte Colony-Stimulating
Factor (Amgen), NSC-614629 PBSC Peripheral Blood Stem Cells TSPA Thiotepa, NSC-6396 2-Drug
Myeloablative Chemotherapy followed by Hematopoietic Rescue. TSPA; CBDCA; followed by ABM or
PROJECTED ACCRUAL: 60 patients will be entered over 3 years. If more than 5 patients on any
arm experience treatment-related mortality, accrual will be discontinued.
DISEASE CHARACTERISTICS: Glioblastoma multiforme (GBM) or brain stem tumor following
surgery (if feasible) and local radiotherapy, as follows: Pathologically confirmed primary
GBM Gliosarcomas and multifocal GBM eligible Unbiopsied diffuse intrinsic pontine tumors
Nonenhancing with gadolinium on MRI T1 hypodense and T2 hyperdense No recurrent or
progressing disease following radiotherapy No leptomeningeal dissemination by radiographic
evaluation including head MRI and either whole-spine MRI with gadolinium or myelogram
Positive CSF cytology alone allowed No extraneural metastases
PATIENT CHARACTERISTICS: Age: 6 to under 60 Performance status: Karnofsky 70%-100% (over
age 16) Lansky 70%-100% (ages 6-16) Hematopoietic: Not specified Hepatic: Bilirubin less
than 2.0 mg/dL AST or ALT less than 5 times normal PT and aPTT normal (consult with
principal investigator if abnormal) Renal: Creatinine clearance at least 50 mL/min/1.73
sqm Cardiovascular: No evidence of myocardial infarction or ischemia on EKG Other: No
active infection at time of leukapheresis Able to tolerate anticoagulation
PRIOR CONCURRENT THERAPY: Radical surgery and involved-field radiotherapy (at least 4,500
cGy) completed within 6 weeks prior to entry Second surgical debulking following
radiotherapy strongly encouraged for patients with residual tumor mass or suspected
radionecrosis Requirement for surgery waived for unresectable brainstem tumors No prior
chemotherapy except corticosteroids