autologous blood and marrow transplantation - Blog Science ...

266 Chapter 6: Breast Cancer
18 months after transplant. In addition, we found an extremely strong correlation
between the presence of clonogenic tumor cells in the marrow or PBPC and a poor
posttransplant outcome (relapse in 51 of 52 instances). Taken together, the ICC and
clonogenic assay provide complementary and prognostic information. Detection of
occult tumor cells with these assays identifies patients who are poor transplant
candidates.
INTRODUCTION
Autologous PBPC transplant following high-dose therapy is being used with
increasing frequency for patients with breast cancer. While some patients appear to
benefit, many relapse for a variety of reasons. These include a high in vivo tumor
burden, the development of drug resistance, lack of a tumor immune response by the
patient's hematopoietic cells, and reinfusion of malignant cells that contaminate the
stem cell products. The detection and quantitation of the residual breast cancer cells
both in vivo and in the graft may be helpful in determining the prognosis of individual
patients. We have developed ultrasensitive ICC methods to detect tumor cells in the
marrow and PBPC. In addition, we have developed a tumor clonogenic assay that can
determine the growth potential of occult residual breast cancer cells. With these new
technologies, it is now possible to determine the incidence and clinical significance of
tumor cells in the marrow and PBPC in the autotransplant patient. We used these assays
to evaluate the marrow and PBPC from 246 patients with stage IV breast cancer.
MATERIALS AND METHODS
Participating centers
This protocol was approved by the Institutional Review Board for Human
Investigation at each center, and patients gave written informed consent.
Participating treating institutions included Ireland Cancer Center at Case Western
University, Cleveland, OH; Johns Hopkins Medical Center, Baltimore, MD; the
Arthur James Cancer Hospital at Ohio State University Medical Center, Columbus,
OH; Response Oncology, Memphis, TN; the James Brown Cancer Center, Humana
Hospital-University of Louisville, Louisville, KY; Northern New Jersey Cancer
Center, Hackensack, NJ; and Texas Oncology, Dallas, TX. Patients were enrolled
into the study from 1991 to 1997.
Patient population
Patients with histologically documented metastatic breast adenocarcinoma
were eligible. Patients were evaluated using physical exam, external imaging