High-dose chemotherapy with autologous hematopoietic stem-cell support for breast cancer in North America.
OBJECTIVE
To identify trends in high-dose therapy with autologous hematopoietic stem-cell support (autotransplants) for breast cancer (1989 to 1995).


METHODS
Analysis of patients who received autotransplants and were reported to the Autologous Blood and Marrow Transplant Registry. Between January 1, 1989 and June 30, 1995, 19,291 autotransplants were reviewed; 5,886 were for breast cancer. Main outcomes were progression-free survival (PFS) and survival.


RESULTS
Between 1989 and 1995, autotransplants for breast cancer increased sixfold. After 1992, breast cancer was the most common indication for autotransplant. Significant trends included increasing use for locally advanced rather than metastatic disease (P < .00001) and use of blood-derived rather than marrow-derived stem cells (P < .00001). One-hundred-day mortality decreased from 22% to 5% (P < .0001). Three-year PFS probabilities were 65% (95% confidence intervals [Cls], 59 to 71) for stage 2 disease, and 60% (95% Cl, 53 to 67) for stage 3 disease. In metastatic breast cancer, 3-year probabilities of PFS were 7% (95% Cl, 4 to 10) for women with no response to conventional dose chemotherapy; 13% (95% Cl, 9 to 17) for those with partial response; and 32% (95% Cl, 27 to 37) for those with complete response. Eleven percent of women with stage 2/3 disease and less than 1% of those with stage 4 disease participated in national cooperative group randomized trials.


CONCLUSIONS
Autotransplants increasingly are used to treat breast cancer. One-hundred-day mortality has decreased substantially. Three-year survival is better in women with earlier stage disease and in those who respond to pretransplant chemotherapy.
Antman
K H
KH
Breast Cancer Working Committee of the Autologous Blood and Marrow Transplant Registry of North America, Health Policy Institute, Medical College of Wisconsin, Milwaukee, USA. KHA4@columbia.edu
Rowlings
P A
PA
Vaughan
W P
WP
Pelz
C J
CJ
Fay
J W
JW
Fields
K K
KK
Freytes
C O
CO
Gale
R P
RP
Hillner
B E
BE
Holland
H K
HK
Kennedy
M J
MJ
Klein
J P
JP
Lazarus
H M
HM
McCarthy
P L
PL
Saez
R
R
Spitzer
G
G
Stadtmauer
E A
EA
Williams
S F
SF
Wolff
S
S
Sobocinski
K A
KA
Armitage
J O
JO
Horowitz
M M
MM
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000453:epidemiology; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D012042:Registries / Q000706:statistics & numerical data*; D014182:Transplantation, Autologous
D000970:Antineoplastic Agents