Metastatic malignant melanoma has been regarded traditionally as an aggressive cancer highly refractory to standard doses of chemotherapy. Complete responses to standard chemotherapy are less than 5%. To overcome resistance, autologous bone marrow transplantation has been employed in the treatment of this disease. High-dose chemotherapy followed by autologous bone marrow rescue has been associated with increased response rates when compared with standard chemotherapy. A recent survey indicates that at least 283 patients with metastatic melanoma have been treated with this form of therapy thus far. Evaluation of the literature indicates that overall response rates for melanoma patients undergoing autologous bone marrow transplantation range from 46 to 65%, with complete response rates as high as 16%. Although few patients are long-term responders, several patients remain in complete remission for periods of more than one year. Multiple centers are evaluating the utility of high-dose therapy in the high-risk adjuvant setting for patients who present with poor prognosis disease. Data concerning the long-term outcome of this therapy are not available. This article reviews the concepts of high-dose therapy followed by autologous bone marrow transplantation, and the outcomes of patients with malignant melanoma who are treated in this manner.
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