autologous blood and marrow transplantation - Blog Science ...

354 Chapter 6: Breast Cancer
1988 1989 1990 1991 1992 1993 1994 1995 1996 1997
Figure 1. Sources of hematopoietic rescue in patients with breast carcinoma through the
years. EBMT Database.
been more rapid in Europe compared with North America. This may be explained
by the fact that U.S. trials started earlier during the ABMT era when PBPCs were
not routinely available. Hematopoietic growth factors are used in 70-80% of cases
after PBPC reinfusion.
The toxic death rate (defined as death in the first 100 days after transplantation)
has dramatically lowered from 15-18% a decade ago to 2% today (Fig. 2). While
this may be due to the use of PBPC and hematopoietic growth factors, better patient
selection is an important likely factor. In fact, since 1995 high-dose chemotherapy
for refractory breast carcinoma has become a very rare treatment option in Europe
(no more than 3% of all patients receiving PBPC). 2
One of the major reasons for concern lies in the fact that while more than 300
centers are performing high-dose chemotherapy, fewer than 20% treat at least 30
patients per year. Accreditation policies for transplant centers are expected in the
near future.
CHEMOTHERAPY FOR METASTATIC DISEASE
High-dose chemotherapy for metastatic disease still represents nearly one half
of the European activity in this field. From the EBMT database, significantly better
outcome is observed among patients grafted in complete remission compared with
patients treated in a less favorable phase of their disease (partial remission, stable
disease, or even progression) (Fig. 3).