title: High-Dose Chemotherapy and Autologous Hematopoietic Stem Cell Transplantation as Adjuvant Treatment in High-Risk Breast Cancer: Data from the European Group for Blood and Marrow Transplantation Registry.
abstract: The aim of this retrospective study was to assess toxicity and efficacy of adjuvant high-dose chemotherapy (HDC) and autologous hematopoietic stem cell transplantation (AHSCT) in 583 high-risk breast cancer (BC) patients (>3 positive nodes) who were transplanted between 1995 and 2005 in Europe. All patients received surgery before transplant, and 55 patients (9.5%) received neoadjuvant treatment before surgery. Median age was 47.1 years, 57.3% of patients were premenopausal at treatment, 56.5% had endocrine-responsive tumors, 19.5% had a human epidermal growth factor receptor 2 (HER2)-negative tumor, and 72.4% had ≥10 positive lymph nodes at surgery. Seventy-nine percent received a single HDC procedure. Overall transplant-related mortality was 1.9%, at .9% between 2001 and 2005, whereas secondary tumor-related mortality was .9%. With a median follow-up of 120 months, overall survival and disease-free survival rates at 5 and 10 years in the whole population were 75% and 64% and 58% and 44%, respectively. Subgroup analysis demonstrated that rates of overall survival were significantly better in patients with endocrine-responsive tumors, <10 positive lymph nodes, and smaller tumor size. HER2 status did not affect survival probability. Adjuvant HDC with AHSCT has a low mortality rate and provides impressive long-term survival rates in patients with high-risk BC. Our results suggest that this treatment modality should be considered in selected high-risk BC patients and further investigated in clinical trials.
authors.affiliation: Hematology and Stem Cell Transplant Unit, Azienda Ospedaliera BMM, Reggio Calabria, Italy. Electronic address: maxmartino@live.com.
authors.forename: Massimo
authors.initials: M
authors.lastname: Martino
authors.affiliation: Section of Hematology and Bone Marrow Transplant Unit, AO Isituti Ospitalieri di Cremona, Cremona, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Lanza
authors.affiliation: Department of Medical Oncology, Fondazione Salvatore Maugeri I.R.C.C.S., Pavia, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Pavesi
authors.affiliation: Gulhane Medical Academy, Department of Medical Oncology, General Tevfik Saglam Caddesi, Etlik/Ankara, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Öztürk
authors.affiliation: Department of Hematology, Institut Paoli Calmettes, Marseille, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Blaise
authors.affiliation: Department of Medical Oncology, Hospital Clínico Universitario, Salamanca, Spain.
authors.forename: Rubén
authors.initials: R
authors.lastname: Leno Núñez
authors.affiliation: Department of Hematology, Academische Ziekenhuis Maastricht, Maastricht, Netherlands.
authors.forename: Harry C
authors.initials: HC
authors.lastname: Schouten
authors.affiliation: Hematology Department, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Bosi
authors.affiliation: Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Italy.
authors.forename: Ugo
authors.initials: U
authors.lastname: De Giorgi
authors.affiliation: Breast Cancer Unit, AO Isituti Ospitalieri di Cremona, Cremona, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Generali
authors.affiliation: Department of Medical Oncology, Civil Hospital, Ravenna, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Rosti
authors.affiliation: Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Necchi
authors.affiliation: Section of Hematology and Bone Marrow Transplant Unit, AO Isituti Ospitalieri di Cremona, Cremona, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Ravelli
authors.affiliation: Department of Medical Oncology, Misericordia Hospital, Grosseto, Italy.
authors.forename: Carmelo
authors.initials: C
authors.lastname: Bengala
authors.affiliation: European Group for Blood and Marrow Transplantation Study Office, Solid Tumors Working Party-EBMT, Hôpital Saint-Antoine, Assistance Publique des Hôpitaux de Paris, France.
authors.forename: Manuela
authors.initials: M
authors.lastname: Badoglio
authors.affiliation: Department of Medical Oncology, I.R.C.C.S. San Matteo University Hospital Foundation, Pavia, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Pedrazzoli
authors.affiliation: Department of Medical Oncology, di Circolo Hospital, Busto Arsizio, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Bregni
mesh_terms: D000328:Adult; D000368:Aged; D064592:Autografts; D001943:Breast Neoplasms / Q000401:mortality* / Q000628:therapy*; D017024:Chemotherapy, Adjuvant / Q000379:methods; D018572:Disease-Free Survival; D005060:Europe / Q000453:epidemiology; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008875:Middle Aged; D012042:Registries; D015996:Survival Rate
keywords: Autologous hematopoietic stem cell transplantation; High-dose chemotherapy; High-risk breast cancer