autologous blood and marrow transplantation - Blog Science ...

Fields et al.
Stage II; 4-9 Pos LN (n=12)
Stage II; >9 Pos LN (n=32)
Stage III; Non-inflam (n=69)
Stage III; Inflam (n=17)
0 1 2 3 4 5 6 7 8
Years After Transplant
Figure 1. Progression-free survival for all patients with early-stage breast cancer treat
in the adjuvant setting.
to define prognostic factors predictive of long-term, progression-free survival. It is
apparent from these data that there are subgroups of patients likely to derive benefit
from this type of therapy. Evaluation of standard and novel prognostic indicators
can provide further insight into the appropriate role of high-dose therapy in the
management of patients with high-risk breast cancer.
In the adjuvant setting, the presence of inflammatory breast cancer remains an
important negative prognostic indicator. We and others have consistently described
poor outcomes for this group of patients, 5
and future studies should be directed at
improving clinical outcomes for this disease. However, novel prognostic indicators
may be of more use to identify high-risk populations in patients with noninflam­
matory breast cancer treated in the adjuvant setting. The current study confirms that
the presence of minimal bone marrow metastases as detected using PCR for
cytokeratin 19 is associated with a poor prognosis, not only in patients with known
metastatic disease as previously described, 8
but also in patients treated in the
adjuvant setting. These findings have been confirmed by several authors, in both
early and advanced-stage disease. 11-13
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In addition, the presence of contaminating
tumor cells in peripheral blood stem cell collections may influence outcome.
Whether this phenomenon represents residual chemoresistant disease in the patient
at the time of high-dose therapy or clonogenic cells within the graft with metastatic
potential remains unclear. Future studies to target residual tumor cells in both the
patient and the graft may lead to improved outcomes for this group of patients.