High-dose chemotherapy with autologous stem cell rescue in women with metastatic breast cancer with involved bone marrow : a role for peripheral blood progenitor transplant

• Published in: Bone marrow transplantation (Basingstoke) Vol. 13; no. 4; pp. 449 - 454
• Main Authors: MYERS, S. E, MICK, R, WILLIAMS, S. F
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing Group 01.04.1994
• Subjects: Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Blood Component Transfusion; Blood Transfusion, Autologous; Bone Marrow - pathology; Bone marrow, stem cells transplantation. Graft versus host reaction; Breast Neoplasms - drug therapy; Breast Neoplasms - mortality; Breast Neoplasms - pathology; Breast Neoplasms - therapy; Combined Modality Therapy; Cyclophosphamide - administration & dosage; Female; Hematopoietic Stem Cells; Humans; Medical sciences; Middle Aged; Neoplasm Metastasis; Pancytopenia - chemically induced; Pancytopenia - therapy; Remission Induction; Retrospective Studies; Survival Analysis; Thiotepa - administration & dosage; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Treatment Failure; Antineoplastic agent; Human; Mammary gland diseases; Autograft; Chemotherapy; Treatment; Stem cell; Hematopoietic cell; Bone marrow; Mammary gland; Metastasis; Malignant tumor
• ISSN: 0268-3369; 1476-5365

This retrospective analysis was done to determine the response rate and survival of women with metastatic breast cancer with bone marrow involvement treated with high-dose cyclophosphamide and thiotepa and peripheral progenitor cell rescue. Eligibility criteria included histologically-documented metastatic breast cancer and either stable disease, a partial response or a complete response to conventional dose chemotherapy. Due to bone marrow involvement, all patients received peripheral progenitor cell reinfusion. Purging of the stem cell product was not performed. Cyclophosphamide (CY) 7.5 gm/m2 total dose and thiotepa 675 mg/m2 total dose was used as the intensification regimen. Of 27 treated patients, 4 (14%) died of treatment-related toxicity. Three patients were in complete remission after induction chemotherapy and remained so after high-dose chemotherapy. Three patients converted from a partial response after induction to a complete response after transplant. This yielded a complete remission rate of 21%. Five of these six patients continue in CR at 5, 6, 11, 14, and 26 months post-transplant. Eight patients (29%) are alive with stable disease post transplant. Ten patients developed disease progression. Six patients died shortly after disease progression; however, four patients are alive with disease at 18, 26, 33, and 53 months post-transplant. The median time to treatment failure is 12 months. In women with metastatic breast cancer with bone marrow involvement, durable responses after high-dose chemotherapy are possible utilizing peripheral blood progenitor support rather than marrow purging.