title: High-dose chemotherapy and hematopoietic support for patients with high-risk primary breast cancer and involvement of 4 to 9 lymph nodes.
abstract: Despite modern chemotherapy, advanced breast cancer remains a significant cause of cancer morbidity and mortality in women. Patients with disease involvement of multiple lymph nodes represent a subgroup with a high risk of relapse. In particular, 50% of patients with 4 to 9 axillary lymph nodes involved will relapse after standard chemotherapy. In an effort to improve the survival of patients with 4 to 9 involved nodes, we performed a phase II study in which 61 patients with surgically diagnosed stage II or III breast cancer and 4 to 9 positive lymph nodes received 3 cycles of doxorubicin and 5-fluorouracil followed by high-dose chemotherapy consisting of cisplatin, cyclophosphamide, and carmustine and infusion of autologous hematopoietic progenitor cells. All patients received posttransplantation localized radiotherapy unless contraindicated, and all patients with hormone receptor-positive disease received tamoxifen. After a median patient follow-up of 6.7 years (range, 4.6-8.6 years), the 5-year overall survival rate was 79% (95% CI, 69%-90%), with relapse-free survival of 73% (95% CI, 62%-85%). Treatment-related mortality was 3%. Interstitial pneumonitis occurred in 69% of patients but did not contribute to mortality. Our study presents long-term favorable results regarding the use of consolidative HDC with autologous hematopoietic support in previously untreated patients with high-risk primary breast cancer.
authors.affiliation: Division of Bone Marrow Transplantation, Stanford University Medical Center, Stanford, California, USA.
authors.forename: Monic J
authors.initials: MJ
authors.lastname: Stuart
authors.forename: William P
authors.initials: WP
authors.lastname: Peters
authors.forename: Gloria
authors.initials: G
authors.lastname: Broadwater
authors.forename: Atif
authors.initials: A
authors.lastname: Hussein
authors.forename: Maureen
authors.initials: M
authors.lastname: Ross
authors.forename: Lawrence B
authors.initials: LB
authors.lastname: Marks
authors.forename: Rodney J
authors.initials: RJ
authors.lastname: Folz
authors.forename: Gwynn D
authors.initials: GD
authors.lastname: Long
authors.forename: David
authors.initials: D
authors.lastname: Rizzieri
authors.forename: Nelson J
authors.initials: NJ
authors.lastname: Chao
authors.forename: James J
authors.initials: JJ
authors.lastname: Vredenburgh
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology* / Q000601:surgery / Q000628:therapy*; D002330:Carmustine / Q000008:administration & dosage; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D015999:Multivariate Analysis; D018579:Patient Selection; D011994:Recombinant Proteins; D012044:Regression Analysis; D033581:Stem Cell Transplantation; D016019:Survival Analysis; D014182:Transplantation, Autologous
chemical_list: D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor; D003520:Cyclophosphamide; D002945:Cisplatin; D002330:Carmustine