High-dose chemotherapy and CD34-selected peripheral blood progenitor cell transplantation for patients with breast cancer metastatic to bone and/or bone marrow.
Fifty women with breast cancer metastatic to bone or bone marrow involvement on light microscopy at the time of initial evaluation were treated with high-dose chemotherapy (HDC) and peripheral blood progenitor cell (PBPC) transplantation with CD34(+) cell selection using the Isolex 300i system. All patients received induction chemotherapy. PBPC were mobilized with chemotherapy and granulocyte colony-stimulating factor. The median CD34(+) progenitor purity was 94.7% (range 72-98.7%) and recovery 38.4% (range 21-60%). Forty-eight hours after HDC with cyclophosphamide, cisplatin and carmustine, PBPC were reinfused. Median time to neutrophil count >0.5 x 10(9)/l was 9 (range 9-12) days and to platelet transfusion independence 11 (4-30) days. These data demonstrate that selected CD34(+) PBPCs allow rapid hematologic reconstitution after HDC. During follow-up, 23% of patients developed herpes zoster. Two patients developed cytomegalovirus infections. Three patients developed fungal infections. The development of these infections was not associated with steroid use but appeared more frequently in patients with diabetes mellitus. Seventy-four per cent of patients received steroids for pulmonary toxicity. Treatment-related mortality was 4%. Progression-free survival and overall survival at 35 months was 22.4% and 40.5%, with a median of 11.4 months and 15.4 months, respectively.
Klein
J L
JL
Barbara Ann Karmanos Cancer Center, Wayne State University School of Medicine, Division of Hematology and Oncology, Detroit, MI, USA.
Hamm
C
C
Dansey
R D
RD
Karanes
C
C
Abella
E
E
Cassells
L
L
Peters
W P
WP
Baynes
R D
RD
D000328:Adult; D018943:Anthracyclines / Q000008:administration & dosage; D018952:Antigens, CD34 / Q000032:analysis*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D019046:Bone Marrow Neoplasms / Q000737:chemistry / Q000188:drug therapy / Q000556:secondary* / Q000628:therapy; D001859:Bone Neoplasms / Q000737:chemistry / Q000188:drug therapy / Q000556:secondary* / Q000628:therapy; D001943:Breast Neoplasms / Q000737:chemistry / Q000188:drug therapy* / Q000628:therapy*; D002469:Cell Separation; D018572:Disease-Free Survival; D000077143:Docetaxel; D004317:Doxorubicin / Q000008:administration & dosage; D004334:Drug Administration Schedule; D005260:Female; D019650:Hematopoietic Stem Cell Mobilization; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007150:Immunohistochemistry; D008875:Middle Aged; D017239:Paclitaxel / Q000008:administration & dosage / Q000031:analogs & derivatives*; D043823:Taxoids; D014747:Vinblastine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000077235:Vinorelbine
D018943:Anthracyclines; D018952:Antigens, CD34; D043823:Taxoids; D000077143:Docetaxel; D014747:Vinblastine; D004317:Doxorubicin; D017239:Paclitaxel; D000077235:Vinorelbine