title: High-dose chemotherapy, autologous bone marrow or stem cell transplantation and post-transplant consolidation chemotherapy in patients with advanced breast cancer.
abstract: This study was designed to determine the complete response (CR) rate, event-free survival (EFS) and overall survival (OS) in patients with metastatic breast cancer treated with an adriamycin-based induction regimen, high-dose chemotherapy consisting of cyclophosphamide and thiotepa with autologous bone marrow or stem cell reinfusion, followed by post-transplant 5-fluorouracil and cisplatin. Forty-eight consecutive patients were enrolled and 35 received two to four cycles of a cytoreductive chemotherapy regimen followed by high-dose chemotherapy which included cyclophosphamide and thiotepa. Thirty-three patients with non-progressive disease received at least one cycle of post-transplant 5-fluorouracil and cisplatin. Fifty percent of patients with evaluable disease responded to induction chemotherapy. Three of the 34 patients (9%) evaluable for response to high-dose chemotherapy achieved CR, eight (24%) achieved partial response (PR), 12 (35%) had stable disease (SD) and 11 (32%) had progressive disease (PD). The median time to neutrophil recovery was 11.5 days (range, 8 to 40 days) post- reinfusion. The median time to platelet independence was 14.5 days (range, 8 to 44 days). The median follow-up is 24.5 months (range, 1 to 96 months). The actuarial probability of EFS for all patients is 17% at 4 years. The EFS for patients receiving all four cycles of post-transplant chemotherapy is 27% at 4 years, compared to 36% at 1 year for patients not receiving any post-transplant chemotherapy. Ten of the 48 patients (21%) are alive, and seven of these (15%) have no evidence of disease. High-dose chemotherapy with autologous bone marrow or peripheral blood-derived stem cell transplantation followed by post-transplant consolidation chemotherapy in patients with metastatic breast cancer results in a proportion of patients without evidence of disease at 4 years.
authors.affiliation: Department of Medicine, Robert H Lurie Cancer Center of Northwestern University, Northwestern University Medical School, Chicago, IL 60611, USA.
authors.forename: M S
authors.initials: MS
authors.lastname: Tallman
authors.forename: A W
authors.initials: AW
authors.lastname: Rademaker
authors.forename: L
authors.initials: L
authors.lastname: Jahnke
authors.forename: S G
authors.initials: SG
authors.lastname: Brown
authors.forename: A
authors.initials: A
authors.lastname: Bauman
authors.forename: C
authors.initials: C
authors.lastname: Mangan
authors.forename: C
authors.initials: C
authors.lastname: Kelly
authors.forename: H
authors.initials: H
authors.lastname: Rubin
authors.forename: M S
authors.initials: MS
authors.lastname: Kies
authors.forename: J
authors.initials: J
authors.lastname: Shaw
authors.forename: K
authors.initials: K
authors.lastname: Kiel
authors.forename: L I
authors.initials: LI
authors.lastname: Gordon
authors.forename: W J
authors.initials: WJ
authors.lastname: Gradishar
authors.forename: J N
authors.initials: JN
authors.lastname: Winter
mesh_terms: D000328:Adult; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation; D001943:Breast Neoplasms / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D018906:Antineoplastic Agents, Alkylating