title: Reduced mortality following bone marrow transplantation for breast cancer with the addition of peripheral blood progenitor cells is due to a marked reduction in veno-occlusive disease of the liver.
abstract: Clinical trials involving breast cancer in the Duke University Bone Marrow Transplant Program were evaluated to assess the association between type of hematopoietic support and treatment-related morbidity/mortality. Case histories of patients treated with high-dose chemotherapy and hematopoietic rescue on three separate protocols between 1986 and 1994 were reviewed. This included 307 patients with stage IV disease and 85 patients with high-risk (10 or more positive axillary lymph nodes) stage II or III disease. One hundred and twenty-eight of these patients were rescued with autologous bone marrow (BM) alone and 264 additionally received autologous peripheral blood progenitor cells (PBPC). The 100 day transplant-related mortality rate in those patients who received BM alone was 20.3%, with an overall mortality rate due to the high-dose chemotherapy procedure of 24.2%. The PBPC-treated group experienced a 100 day transplant-related mortality of only 6.1% and an overall trans-plant- related mortality of 10.2%. Sixteen of 31 deaths were attributed to veno-occlusive disease (VOD) in the group that received BM alone compared to only one VOD-related death in the PBPC group. These data demonstrate a marked improvement in transplant-related mortality which is related to the use of PBPC. This effect has been almost entirely due to a reduction in mortality from hepatic veno-occlusive disease.
authors.affiliation: Bone Marrow Transplant Program, Dept of Medicine, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: D C
authors.initials: DC
authors.lastname: Fisher
authors.forename: J J
authors.initials: JJ
authors.lastname: Vredenburgh
authors.forename: W P
authors.initials: WP
authors.lastname: Petros
authors.forename: A
authors.initials: A
authors.lastname: Hussein
authors.forename: D A
authors.initials: DA
authors.lastname: Berry
authors.forename: M
authors.initials: M
authors.lastname: Elkordy
authors.forename: P
authors.initials: P
authors.lastname: Rubin
authors.forename: C J
authors.initials: CJ
authors.lastname: Gilbert
authors.forename: W P
authors.initials: WP
authors.lastname: Peters
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D016026:Bone Marrow Transplantation / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D001943:Breast Neoplasms / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D006504:Hepatic Veno-Occlusive Disease / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D006801:Humans; D008875:Middle Aged
chemical_list: D000970:Antineoplastic Agents