High-dose chemotherapy with autologous bone marrow transplantation for the treatment of metastatic breast cancer.

1992 ◽  
Vol 10 (4) ◽  
pp. 657-670 ◽  
Author(s):  
D M Eddy
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Autologous Bone Marrow Transplantation ◽  
Metastatic Breast ◽  
Autologous Bone Marrow ◽  
High Dose Chemotherapy ◽  
High Rate ◽  
High Dose ◽  
Randomized Controlled ◽  
Conventional Dose

PURPOSE This review was undertaken to examine the evidence of effectiveness of high-dose chemotherapy and autologous bone marrow transplantation (HDC/ABMT) for the treatment of metastatic breast cancer and to compare the magnitudes of the benefits and harms of HDC/ABMT with those of conventional doses of chemotherapy. DESIGN Published studies were reviewed and analyzed. RESULTS No randomized controlled trials have been published that evaluate HDC/ABMT. Only one internally controlled study has been conducted; it demonstrated that HDC/ABMT and conventional treatment have virtually identical outcomes. Comparisons of uncontrolled clinical series are confounded by patient selection and other biases. Gross comparisons indicate that, compared with conventional-dose chemotherapy, HDC/ABMT achieves (1) higher complete response rates (36% v 8%), (2) higher overall response rates (70% v 39%), (3) similar median response durations (8 months v 9.6 months), (4) similar median survival durations (16 months v 16.6 months), and (5) similar overall survival rates (eg, 43% 2-year survival v 39%). Observations of cases with longer-term disease-free survival are promising but not conclusive. High-dose chemotherapy with ABMT has a higher treatment-related mortality rate (5% to 15% v 1%), a high rate of nonmortal toxicity (approximately 30%), and a high rate of side effects (approaching 100%). CONCLUSIONS Firm conclusions are not possible because of the lack of controlled studies and the presence of numerous biases. However, the existing evidence does not demonstrate that HDC/ABMT is superior to conventional-dose chemotherapy for the treatment of metastatic breast cancer. Randomized controlled trials are needed.

Tandem autotransplantation for the treatment of metastatic breast cancer.

1995 ◽  
Vol 13 (8) ◽  
pp. 2050-2055 ◽  
Author(s):  
E R Broun ◽  
R Sridhara ◽  
G W Sledge ◽  
D Loesch ◽  
P H Kneebone ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Autologous Bone Marrow Transplantation ◽  
Metastatic Breast ◽  
Progression Free Survival ◽  
Autologous Bone Marrow ◽  
High Dose Chemotherapy ◽  
High Response Rate ◽  
High Dose ◽  
Conventional Dose

PURPOSE To investigate the tolerability and impact on progression-free and overall survival of two consecutive cycles of high-dose chemotherapy (HDC) with autologous bone marrow transplantation (ABMT) in patients with previously untreated metastatic breast cancer. PATIENTS AND METHODS Twenty-eight patients received conventional-dose induction therapy (ITx) followed by a planned two cycles of HDC with ABMT. Median age was 45 years (range, 34 to 60 years). Sites of disease were bone (seven patients), visceral (three), soft tissue (11), multiple (six), and CNS (one). The ITx regimens of cyclophosphamide, Adriamycin (doxorubicin; Adria Laboratories, Columbus, OH), methotrexate, fluorouracil, prednisone, and tamoxifen (CAMFTP) (three patients); fluorouracil, doxorubicin, and cyclophosphamide (FAC; 11 patients); cyclophosphamide, methotrexate, and fluorouracil (CMF; four patients); or doxorubicin or mitoxantrone/cyclophosphamide (10 patients) were given to maximum response (three to five cycles). HDC was cyclophosphamide 6 g/m2, carboplatin 2 g/m2, and etoposide 625 mg/m2 with ABMT. RESULTS Of 28 patients, 24 received two (86%) cycles of HDC. Four received only one cycle due to persistent toxicity from course 1 (one patient), no response to course 1 (two), and death on course 1 (one). Grade 3 to 4 nonhematologic toxicities included mucositis (in one or both cycles in 21 of 28 patients; 75%), diarrhea, nausea, and vomiting. Reversible peripheral neuropathy was seen in 15 of 28 patients and was severe in one. Documented infections were seen in 19 of 52 cycles. There was one transplant-related death. Six patients were converted from partial remission (PR) to complete remission (CR) with HDC; two of 24 patients (8%) were converted from PR to CR with the second cycle of HDC. Progression-free survival rate is nine of 28 patients (32%) with median follow-up of 23 months (range, 13 to 36+ months). Eighteen of 28 patients (64%) have progressed at 1 to 17 months from ABMT. CONCLUSION Two cycles of HDC with ABMT was well tolerated with a high response rate in patients with metastatic breast cancer. The importance of the second cycle of HDC in this population is unclear.

Treatment of metastatic breast cancer with a split-course high-dose chemotherapy regimen and autologous bone marrow transplantation.

1994 ◽  
Vol 12 (2) ◽  
pp. 342-346 ◽  
Author(s):  
R Ghalie ◽  
C M Richman ◽  
S S Adler ◽  
M A Cobleigh ◽  
A D Korenblit ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Bone Marrow ◽  
Metastatic Breast Cancer ◽  
Autologous Bone Marrow Transplantation ◽  
Metastatic Breast ◽  
Autologous Bone Marrow ◽  
Complete Response ◽  
High Dose Chemotherapy ◽  
High Dose ◽  
Autologous Bone

PURPOSE We investigated the role of high-dose chemotherapy and autologous bone marrow transplantation (ABMT) as the initial systemic treatment in patients with hormone-unresponsive metastatic breast cancer. We studied a regimen involving a split-course schedule using sequential administration of two pairs of alkylating agents separated by 5 days of rest. The rest period was intended to provide time for recovery from the treatment-immediate adverse effects, thereby allowing further dose escalation. PATIENTS AND METHODS The treatment consisted of thiotepa 225 to 300 mg/m2/d (days - 11 to -9), cisplatin 50 to 100 mg/m2/d (days - 11 and -3), and cyclophosphamide 60 mg/kg/d (days - 3 and -2). Dose escalation was performed in the initial 15 patients before reaching dose-limiting toxicities. When feasible, responding patients received posttransplant irradiation to sites of residual or prior bulky disease. Patients with bone marrow or CNS involvement, prior pelvic irradiation, or age greater than 55 years were excluded. RESULTS Thirty-nine patients with measurable or assessable tumor were enrolled: 23 with visceral metastases, 11 with only soft tissue disease, and five with skeletal involvement. Twenty-five patients had received no chemotherapy for metastatic disease before transplantation. The dose-limiting toxicities of this therapy were renal and gastrointestinal. Six patients died from complications: four of a fungal infection and two of hemorrhage. A complete response was achieved in 14 patients (36%), three of whom are free of disease at 79+, 55+, and 40+ months after transplantation. Ten of 25 patients not treated with standard-dose chemotherapy for metastatic disease achieved a complete response (40%). The three patients in continuous remission were in the untreated relapse group. CONCLUSION This single high-dose treatment achieved a relatively high complete response rate in patients with metastatic breast cancer and may have cured some of them. On the other hand, the split-course dose schedule as tested here did not permit significant dose-intensification.

High-Dose Chemotherapy With Autologous Bone Marrow Transplantation for the Treatment of Metastatic Breast Cancer

1992 ◽  
Vol 10 (10) ◽  
pp. 1655-1658 ◽  
Author(s):  
David M. Eddy
Keyword(s):  
Breast Cancer ◽  
Bone Marrow ◽  
Metastatic Breast Cancer ◽  
Bone Marrow Transplantation ◽  
Autologous Bone Marrow Transplantation ◽  
Metastatic Breast ◽  
Autologous Bone Marrow ◽  
High Dose Chemotherapy ◽  
High Dose ◽  
Autologous Bone

Tables 1 to 4 contained errors in the report "High-Dose Chemotherapy With Autologous Bone Marrow Transplantation for the Treatment of Metastatic Breast Cancer" by Eddy (J Clin Oncol 10:657–670, 1992). They are reprinted here correctly in their entirety: Please see the PDF for Table.

Liver transplantation followed by high-dose cyclophosphamide, total-body irradiation, and autologous bone marrow transplantation for treatment of metastatic breast cancer

1984 ◽  
Vol 37 (3) ◽  
pp. 311-312 ◽  
Author(s):  
CHRISTOPH HUBER ◽  
DIETGER NIEDERWIESER ◽  
DIETER SCHONITZER ◽  
ALOIS GRATWOHL ◽  
DEAN BUCKNER ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Bone Marrow ◽  
Liver Transplantation ◽  
Metastatic Breast Cancer ◽  
Autologous Bone Marrow Transplantation ◽  
Metastatic Breast ◽  
Autologous Bone Marrow ◽  
High Dose ◽  
Autologous Bone ◽  
Total Body

scholarly journals Conventional-Dose Chemotherapy Compared with High-Dose Chemotherapy plus Autologous Hematopoietic Stem-Cell Transplantation for Metastatic Breast Cancer

2000 ◽  
Vol 342 (15) ◽  
pp. 1069-1076 ◽  
Author(s):  
Edward A. Stadtmauer ◽  
Anne O'Neill ◽  
Lori J. Goldstein ◽  
Pamela A. Crilley ◽  
Kenneth F. Mangan ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Stem Cell ◽  
Metastatic Breast Cancer ◽  
Hematopoietic Stem Cell Transplantation ◽  
Metastatic Breast ◽  
High Dose Chemotherapy ◽  
High Dose ◽  
Hematopoietic Stem ◽  
Conventional Dose ◽  
Conventional Dose Chemotherapy
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