Results of High Dose Chemotherapy (HDC) and Autologous Peripheral Blood Stem Cell Transplantation (APBSCT) in 45, Patients with Breast Cancer

Abstract

The objective of this study was to assess the toxicity and efficacy of high-dose chemotherapy (HDC) with autologous peripheral stem cell transplantation (APBSCT) in women with metastatic or high risk (?9 axillary nodal involvement) stage II-III breast cancer. Forty-five women with either metastatic (n=23) or high risk (n=22) breast cancer were enrolled in the study and treated with HDC followed by APBSCT. At the time of transplant, the median age was 39 years (range: 26-64). All patients were pretreated with standard chemotherapy regimens. Metastatic patients with progression or stable disease after first-line chemotherapy were excluded. PBSC were harvested using G-CSF and the conditioning regimens ICE (ifosfamide, carboplatin, etoposide) and CNV (cyclophosphamide, mitoxantrone, etoposide) were used in most of the patients. The median number of CD34+ cells infused was 5.40×106/kg (range: 1.82-19.87×106 kg). G-CSF or GM-CSF was used in 39 patients in the post-transplant period. The median leukocyte engraftment (leukocyte<1000/mm3) was 11 days (0-24) and platelet engraftment (20000/mm3) was 11 days (0-27). In the early transplant period (0-30th day), 4 (8.8%) out of 45 patients died due to sepsis, renal failure, ARDS and intracranial hemorrhage. The most common grade II-III toxicities were mucositis (74%), nausea/vomiting (59%), and diarrhea (33%). No grade IV nonhematological toxicity was observed. The median follow-up for metastatic and high-risk groups were 14. months (range: 1-30) and 13 months (range: 1-31), respectively. The overall survival rates were 55% in metastatic and 77% in high-risk groups for two years. In conclusion, HDC with APBSCT is a potentially effective treatment for patients with breast cancer but should be given to selected patients to evaluate its efficacy.