title: Stem cell transplantation for metastatic breast cancer: analysis of tumor contamination.
abstract: The purpose of this study was to determine the efficacy, engraftment kinetics, effect of bone marrow tumor contamination, and safety of high-dose therapy and granulocyte-colony stimulating factor (G-CSF) mobilized peripheral blood progenitor cell (PBPC) support for patients with responding metastatic breast cancer. Forty two patients underwent G-CSF (10 microg/kg) stimulated PBPC harvest. PBPC and bone marrow aspirates were analyzed by histologic and immunocytochemical methods for tumor contamination. Thirty-seven patients received high-dose therapy consisting of cyclophosphamide 6 g/m2, thiotepa 500 mg/m2, and carboplatin 800 mg/m2 (CTCb) given as an infusion over 4 d followed by PBPC reinfusion and G-CSF (5 microg/kg) support. No transplant related deaths or grade 4 toxicity was recorded. CD34+ cells/kg infused was predictive of neutrophil and platelet recovery. With a median follow-up of 38 months, three year survival was 44% with relapse-free survival of 19%. Histological bone marrow involvement, found in 10 patients, was a negative prognostic factor and was associated with a median relapse-free survival of 3.5 months. Tumor contamination of PBPC by immunohistochemical staining was present in 22.5% of patients and found not to be correlated with decreased survival. G-CSF stimulated PBPC collection followed by a single course of high dose chemotherapy and stem cell infusion with G-CSF stimulated marrow recovery leads to rapid, reliable engraftment with low toxicity and promising outcome in women with responding metastatic breast cancer.
authors.affiliation: Bone Marrow and Stem Cell Transplant Program, University of Pennsylvania Cancer Center, Philadelphia 19104, USA. stadtmau@mail.med.upenn.edu
authors.forename: E A
authors.initials: EA
authors.lastname: Stadtmauer
authors.forename: D E
authors.initials: DE
authors.lastname: Tsai
authors.forename: C J
authors.initials: CJ
authors.lastname: Sickles
authors.forename: R
authors.initials: R
authors.lastname: Mick
authors.forename: S M
authors.initials: SM
authors.lastname: Luger
authors.forename: D L
authors.initials: DL
authors.lastname: Porter
authors.forename: P A
authors.initials: PA
authors.lastname: Mangan
authors.forename: L M
authors.initials: LM
authors.lastname: Schuchter
authors.forename: S J
authors.initials: SJ
authors.lastname: Schuster
authors.forename: E Y
authors.initials: EY
authors.lastname: Loh
authors.forename: D A
authors.initials: DA
authors.lastname: Magee
authors.forename: R A
authors.initials: RA
authors.lastname: Sachs
authors.forename: M E
authors.initials: ME
authors.lastname: Wall
authors.forename: J
authors.initials: J
authors.lastname: Moore
authors.forename: G P
authors.initials: GP
authors.lastname: Buzby
authors.forename: E
authors.initials: E
authors.lastname: Zaleta
authors.forename: M
authors.initials: M
authors.lastname: Kamoun
authors.forename: L E
authors.initials: LE
authors.lastname: Silberstein
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D019046:Bone Marrow Neoplasms / Q000556:secondary; D001859:Bone Neoplasms / Q000556:secondary; D001943:Breast Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D019650:Hematopoietic Stem Cell Mobilization / Q000009:adverse effects; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006412:Hematopoietic Stem Cells / Q000473:pathology*; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009360:Neoplastic Cells, Circulating / Q000473:pathology; D011446:Prospective Studies
chemical_list: D016179:Granulocyte Colony-Stimulating Factor