title: Long-term survival after high-dose chemotherapy with autologous hematopoietic cell transplantation in metastatic breast cancer.
abstract: OBJECTIVE
  The most common indication for high-dose chemotherapy (HDC) and autologous hematopoietic cell transplantation (AHCT) in the 1990s was breast cancer. Several randomized trials and a more recent meta-analysis failed to show a survival benefit for AHCT in metastatic breast cancer (MBC); however, they demonstrated a better-than-expected 10-year to 15-year survival in 5-15% of patients. We thus evaluated the long-term results of treatment with HDC and AHCT in MBC at our institution.
  
  
  METHODS
  From 1984 to 2000, 285 patients underwent AHCT for MBC. The patient characteristics were collected through the Cleveland Clinic, United Transplant Database. A retrospective review of the medical records of the long-term surviving breast-cancer patients treated with HDC and AHCT was conducted.
  
  
  RESULTS
  With a median follow-up of 169 months, 34 (12%) remain alive. Of the 251 patients who died, 218 (87%) died of metastatic disease. A comparison by age (<50 years and >50 years) and hormonal status did not demonstrate any differences in relapse (p=.33 and p=.32, respectively) or survival (p=.13 and p=.42). Of the 34 long-term survivors, sufficient data were available on 28 patients, and further evaluation revealed that the majority had a primary or locally recurrent oligometastatic disease.
  
  
  CONCLUSIONS
  This retrospective evaluation of patients who underwent AHCT for MBC demonstrates long-term survival in a small subset of patients, primarily those with primary or recurrent oligometastatic disease. Oligometastatic breast cancer is a distinct entity within MBC, which may be curable with multimodality therapy. We thus conclude there remains no overall-survival benefit to HDC in MBC.
authors.affiliation: Bone Marrow Transplant Program, Department of Hematologic Oncology and Blood Disorders, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA. Electronic address: hamiltb2@ccf.org.
authors.forename: Betty Ky
authors.initials: BK
authors.lastname: Hamilton
authors.affiliation: Quantitative Health Sciences, Cleveland Clinic Lerner Research Institute, Cleveland, OH, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Rybicki
authors.affiliation: Bone Marrow Transplant Program, Department of Hematologic Oncology and Blood Disorders, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA.
authors.forename: Donna
authors.initials: D
authors.lastname: Abounader
authors.affiliation: Bone Marrow Transplant Program, Department of Hematologic Oncology and Blood Disorders, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Andresen
authors.affiliation: Bone Marrow Transplant Program, Department of Hematologic Oncology and Blood Disorders, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA.
authors.forename: Matt
authors.initials: M
authors.lastname: Kalaycio
authors.affiliation: Bone Marrow Transplant Program, Department of Hematologic Oncology and Blood Disorders, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA.
authors.forename: Ronald
authors.initials: R
authors.lastname: Sobecks
authors.affiliation: Bone Marrow Transplant Program, Department of Hematologic Oncology and Blood Disorders, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA.
authors.forename: Brad
authors.initials: B
authors.lastname: Pohlman
authors.affiliation: Pediatric Hematology Oncology, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Rabi
authors.initials: R
authors.lastname: Hanna
authors.affiliation: Bone Marrow Transplant Program, Department of Hematologic Oncology and Blood Disorders, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Dean
authors.affiliation: Bone Marrow Transplant Program, Department of Hematologic Oncology and Blood Disorders, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA.
authors.forename: Hien
authors.initials: H
authors.lastname: Liu
authors.affiliation: Bone Marrow Transplant Program, Department of Hematologic Oncology and Blood Disorders, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Hill
authors.affiliation: Bone Marrow Transplant Program, Department of Hematologic Oncology and Blood Disorders, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Bolwell
authors.affiliation: Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC, USA.
authors.forename: Edward
authors.initials: E
authors.lastname: Copelan
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000628:therapy; D018567:Breast Neoplasms, Male / Q000188:drug therapy / Q000401:mortality* / Q000628:therapy; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis; D012008:Recurrence; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents
keywords: Autologous hematopoietic cell transplant; High-dose chemotherapy; Oligometastatic breast cancer