Micrometastatic bone marrow cells at diagnosis have no impact on survival of primary breast cancer patients with extensive axillary lymph node involvement treated with stem cell-supported high-dose chemotherapy.
BACKGROUND
To determine the impact of micrometastatic bone marrow cells (MMC) on survival in high-risk primary breast cancer (HRPBC) patients treated with high-dose chemotherapy (HDCT) and autologous stem cell transplantation (ASCT).


METHODS
Ninety-one HRPBC patients (73 patients with > or =10 involved axillary lymph nodes (ALN), 18 premenopausal women with > or =4 involved ALN) received one cycle (eight patients) or two cycles of HDCT and ASCT. Bone marrow aspiration was performed before systemic treatment to search for MMC using a cocktail of four monoclonal epithelial-specific antibodies (5D3, HEA125, BM7 and BM8). The influence of MMC and other prognostic factors on disease-free survival (DFS), distant DFS (DDFS), and overall survival (OS) was analysed.


RESULTS
In 23 of 91 patients (25%) we detected a median of three MMC (range, 1-43) among 10(6) mononuclear cells. With a median follow-up of 62 months (range, 10-117), the detection of MMC was not associated with DFS (P=0.929), DDFS (P=0.664) or OS (P=0.642). In multivariate analysis the strongest predictor was nodal ratio for DFS (P=0.012) and expression of p53 for OS (P <0.001).


CONCLUSIONS
The detection of MMC at diagnosis has no impact on survival in HRPBC patients treated with HDCT and ASCT.
Schneeweiss
A
A
University of Heidelberg, Department of Gynecology and Obstetrics, Heidelberg, Germany. andreas_schneeweiss@med.uni-heidelberg.de
Diel
I
I
Hensel
M
M
Kaul
S
S
Sinn
H-P
HP
Unnebrink
K
K
Rudlowski
C
C
Lauschner
I
I
Schuetz
F
F
Egerer
G
G
Haas
R
R
Ho
A D
AD
Bastert
G
G
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D001854:Bone Marrow Cells / Q000378:metabolism / Q000473:pathology; D019046:Bone Marrow Neoplasms / Q000556:secondary*; D001943:Breast Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000628:therapy; D004305:Dose-Response Relationship, Drug; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D007150:Immunohistochemistry; D008198:Lymph Nodes / Q000473:pathology; D008593:Menopause / Q000097:blood / Q000187:drug effects; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D033581:Stem Cell Transplantation; D016019:Survival Analysis; D016896:Treatment Outcome