Adjuvant high-dose therapy with peripheral blood stem cell support for patients with high-risk breast cancer

被引:3
作者
Hohaus, S
Martin, S
Schneeweiss, A
Voso, MT
Schlenk, RF
Wallwiener, D
Bastert, G
Haas, R
机构
[1] Heidelberg Univ, Dept Internal Med 5, D-69115 Heidelberg, Germany
[2] Heidelberg Univ, Dept Gynaecol, D-6900 Heidelberg, Germany
[3] German Canc Res Ctr, Clin Cooperat Unit Mol Haematol & Oncol, Heidelberg, Germany
[4] Univ Tubingen, Dept Gynaecol, D-72074 Tubingen, Germany
关键词
breast cancer; high-dose chemotherapy; peripheral blood stem cell transplantation prognostic indicators; tumour cells;
D O I
10.1007/s002800051110
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
We report on the efficacy and toxicity of a sequential high-dose therapy with peripheral blood stem cell (PBSC) support in 107 patients with high-risk stage II/III breast cancer. There were 90 patients with more than 9 tumour-positive axillary lymph nodes. An induction therapy of two cycles of ifosfamide (total dose, 7,500 mg/m(2)) and epirubicin (120 mg/m(2)) was given, and PBSC were harvested during granulocyte colony-stimulating factor (G-CSF)-supported leukocyte recovery following the second cycle. The PBSC-supported high-dose chemotherapy consisted of two cycles of ifosfamide (total dose 12,000 mg/m(2)), carboplatin (900 mg/m(2)) and epirubicin (180 mg/m(2)). Patients were autografted with a median number of 4.1 x 10(6) CD34+ cells/kg (range 1.9-26.5 x 10(6)), resulting in haematological reconstitution within approximately 2 weeks following high-dose therapy. The toxicity was moderate in general, and there was no treatment-related toxic death. Twenty-nine patients (27.1% of all patients) relapsed between 3 and 46 months following the last cycle of high-dose therapy (median 15 months). The probability of disease-free and overall survival at 3 years was 56% and 83%, respectively. A multivariate analysis showed that patients with stage II disease had a significantly better probability of disease-free survival (71%) in comparison with patients with stage III disease (30%). The probability of disease-free survival was also significantly better for patients with oestrogen receptor-positive tumours (62%) compared with patients with receptor-negative ones (40%). In conclusion, sequential high-dose chemotherapy with PBSC support can be safely administered to patients with high-risk stage II/III breast cancer. Further intensification of the therapy including the addition of non-cross-resistant drugs or immunological approaches may be envisaged for patients with stage III disease and hormone receptor-negative tumours.
引用
收藏
页码:S13 / S17
页数:5
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