autologous blood and marrow transplantation - Blog Science ...

296 Chapter 6: Breast Cancer
of rest (day -1), ABSC were reinfused on day 0. Starting within 24 hours, rhG-CSF
at the dose of 5 ug/kg was administered subcutaneously until hematologic recovery.
RESULTS
Ninety-two patients were enrolled into the study. Eighteen patients were
withdrawn from the study after completion of the induction regimen because of PD or
other reasons (increasing renal insufficiency, one patient; diagnosis of a second
cancer, one patient; withdrawal of consent, one patient). Thus far, 74 have undergone
the complete treatment and are évaluable for toxicity and efficacy. In general,
treatment-related toxicity was rather rare and mild, except for hematotoxicity. None of
our patients died from acute toxic complications within the first 6 weeks during and
after transplantation. Transfusion frequency for packed red blood cells after the highdose
chemotherapy ranged between 0 and 26 units for a median of only two units.
There were between 1 and 29 platelet transfusion encounters, for median of only two
encounters. Median time of hematologic recovery to ANC >0.5/nL was 11.5 days
(range 8-17), days to platelet recovery of >20/nL was 12 (range 0-17). The patients'
age was 42 years (19-55). Those who did not fulfill the criteria of response and did
not obtain the HDCT had a median survival of only 8 months. Patients who underwent
HDCT and autologous BSC showed a median survival of 28.5 months. This is longer
than the average for historical controls treated with standard-dose chemotherapy
(SDCT). We performed univariate analysis. From all patients enrolled into the study
(intent-to-treat analysis), the median survival was 28 months if liver was not involved
by metastatic disease, and only 8 months with liver involvement. The hazard ratio of
dying with metastatic breast cancer to the liver was 3.25. Adjuvant chemotherapy
predicted a statistically significant difference in survival: median survival for patients
without adjuvant chemotherapy is 28 months. Patients developing metastasis after
adjuvant chemotherapy have a median survival probability of 13.5 months (difference
significant; P=0.049, log-rank test; hazard ratio 0.54). Prior doxorubicin, bone marrow
involvement, and age did not reveal a significant difference. Figure 1 shows the
probability of survival of all 74 transplanted patients as estimated by the Kapler-Meier
method showing differences in survival in patients with bone metastases and visceral
metastases, respectively (P