Autologous hematopoietic stem cell transplantation for breast cancer in Europe: critical evaluation of data from the European Group for Blood and Marrow Transplantation (EBMT) Registry 1990–1999

Abstract

Summary:The aim of this study was to identify trends in high-dose chemotherapy (HDC) with autologous hematopoietic stem cell transplantation (ASCT) and to assess survival in a large cohort of breast cancer (BC) patients receiving this therapy in Europe from 1990 to 1999. A total of 7471 patients who received HDC with ASCT between January 1, 1990 and December 31, 1999 were reported to the European Group for Blood and Marrow Transplantation Registry. Data required for demographics and survival analysis were available for 2679 patients with high-risk primary BC; 921 patients with inflammatory BC (IBC), and 2295 patients with metastatic disease. The main evaluation parameters were progression-free survival (PFS) and overall survival (OS). Between 1990 and 1998, autotransplants for BC increased 30-fold. Significant trends included use of blood-derived rather than marrow-derived stem cells, increment of reporting centers and decrease of mortality within 100 days from transplantation. The 5-year PFS and OS probabilities were 53 and 68% for high-risk disease and 42 and 53% for IBC, respectively. For metastatic disease 5-year PFS and OS probabilities in the whole cohort were 18 and 27%, respectively, while for women transplanted in complete remission the 5-year PFS was 29%. In conclusion, HDC with ASCT has been increasingly used until 1998 and the 100-day mortality rate has been constantly less than 2% from 1995 to date. The 5-year survival of high-risk BC is related to the number of axillary nodes involved at surgery. Outcome of patients with IBC is encouraging, suggesting the need for randomized trials. Patients with metastatic disease responding to pretransplant chemotherapy and harboring ER+ tumors have a better outcome.

A randomized phase III comparative trial of immediate consolidation with high-dose chemotherapy and autologous peripheral blood progenitor cell support compared to observation with delayed consolidation in women with metastatic breast cancer and only bone metastases following intensive induction chemotherapy

“…The European Group for Blood and Marrow Transplantation reviewed their registry data for the past decade. 11 The large series corroborates the individual trials, with a suggestion of improved survival. In contrast, the PBT-1 Study reported by Stadmauer et al 12 showed no differences in PFS or OS between high-dose chemotherapy with hematopoietic support compared with maintenance cyclophosphamide, methotrexate, and 5-fluorouracil (CMF) chemotherapy for women with metastatic breast cancer who responded to conventional induction chemotherapy.…”

Long-term survival in patients with metastatic breast cancer receiving intensified chemotherapy and stem cell rescue: data from the Italian registry

“…36 In our cohort of patients with MBC, women receiving HDC as consolidation therapy after achieving response to SDC had the best prognosis, confirming previous reports. 21,22,37 A significant proportion of such patients are long-term progression-free survivors. Importantly, HDC was effective in producing a CR in 20.4% of patients for whom SDC failed to produce CR; such patients having an outcome superimposable to patients transplanted in CR.…”

A randomized study comparing filgrastim versus lenograstim versus molgramostim plus chemotherapy for peripheral blood progenitor cell mobilization

“…Median duration of growth factor administration until day of apheresis was 13 days (range, [10][11][12][13][14][15][16][17][18][19][20]. The number of days was less for the lenograstim arm with a median number of 12 days (range, 11-16) versus 13 days (range, 10-17) for the filgrastim arm and 14 days (range, [12][13][14][15][16][17][18][19][20] for the molgramostim arm (Po0.0001) ( Table 2).…”

“…11 One or more aphereses were performed until cumulative yield of CD34 þ cells was X2 Â 10 6 /kg, the threshold fixed to guarantee a safe hematological recovery. 12 The PBPC harvest was performed using the spectra COBE BCT, Aphaeresis System (Lakewood, CO, USA).…”