title: Occult tumor contamination of hematopoietic stem-cell products does not affect clinical outcome of autologous transplantation in patients with metastatic breast cancer.
abstract: OBJECTIVE
  To determine whether occult tumor contamination of autologous bone marrow or peripheral-blood progenitor cells (PBPC) influences clinical outcome after high-dose chemotherapy in patients with stage IV breast cancer.
  
  
  METHODS
  We used an immunocytochemical assay capable of detecting one tumor cell in 5 x 10(5) hematopoietic cells to analyze bone marrow and/or PBPC collections obtained from 57 consecutive women with chemotherapy-sensitive metastatic breast cancer who received high-dose chemotherapy. The influence of occult tumor on time to progression, overall survival, and first site of recurrence (old or new) was studied.
  
  
  RESULTS
  Twenty-three of 57 (40%) patients received bone marrow (n=6) or peripheral-blood progenitor collections (n=17) that contained microscopic cancer. Median time to progression and overall survival were 9 and 22 months in patients who did not receive infused tumor cells, compared with 10 and 24 months, respectively, in those who received occult tumor (P=not significant [NS]). Worse survival, but not time to progression, was observed in six patients who received > or = 2/100,000 tumor cells. Regardless of whether occult tumor was infused, the majority of relapses occurred in prior, rather than new sites of disease. Three patients who received stem-cell products contaminated by microscopic breast cancer remain free from progression at 21+, 47+, and 52+ months.
  
  
  CONCLUSIONS
  Microscopic tumor was frequently detected by immunocytochemistry in hematopoietic stem-cell products, but did not predict for inferior treatment outcome in this cohort of patients with metastatic breast cancer. Quantitative information regarding infused tumor burden may have prognostic significance.
authors.affiliation: Department of Medicine, Ireland Cancer Center, Case Western Reserve University, Cleveland, OH 44106, USA. bxc12@po.cwru.edu
authors.forename: B W
authors.initials: BW
authors.lastname: Cooper
authors.forename: T J
authors.initials: TJ
authors.lastname: Moss
authors.forename: A A
authors.initials: AA
authors.lastname: Ross
authors.forename: J
authors.initials: J
authors.lastname: Ybanez
authors.forename: H M
authors.initials: HM
authors.lastname: Lazarus
mesh_terms: D019046:Bone Marrow Neoplasms / Q000150:complications / Q000556:secondary*; D016026:Bone Marrow Transplantation / Q000009:adverse effects; D001943:Breast Neoplasms / Q000473:pathology / Q000628:therapy*; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007150:Immunohistochemistry; D018365:Neoplasm, Residual; D012008:Recurrence; D013997:Time Factors; D014182:Transplantation, Autologous; D016896:Treatment Outcome