Autologous bone marrow transplantation in primary breast cancer: The American experience

The use of high-dose chemotherapy with bone marrow transplantation is becoming easier to administer because of improved supportive care techniques and is being increasingly utilized for patients with high-risk primary breast cancer. We report here survey data from 33 medical centers in the United States using this therapeutic approach in 662 patients outside of the cooperative group sponsored randomized clinical trials between 1987 and 1993. Centers provided patient specific data on pretreatment characteristics, therapy and supportive care used, and disease outcome and toxicity data for each patient. Seventy-four percent of the patients were treated by 11 (33%) of the centers; 15 institutions had treated fewer than 10 patients. The median number of lymph nodes involved was 13; the majority of patients (51%) had T2 lesions and 28% of tumors measured more than 5 cm. The most common induction chemotherapy regimens were CAF or AFM, and 72% of patients received one of three transplant preparative regimens. Overall survival at 3 years was 79% (95% CI: 71%-85%) with event-free survival at three years of 69% (95% CI: 61%-76%). Patients with hormone-receptor positive tumors had a event-free (p = 0.02) and overall survival (p = 0.01) that was significantly greater than patients with hormone receptor negative tumors. High-dose chemotherapy with autologous cellular support as consolidation in patients with high-risk primary breast cancer produces event-free and overall survival which appears superior to historical and contemporary data in this setting using standard-dose chemotherapy.

Duke Scholars

Author Gwynn Douglas Long Medicine, Hematologic Malignancies and Cellular Therapy