Stem cell transplantation for metastatic breast cancer: analysis of tumor contamination |
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Authors: | Edward A Stadtmauer Donald E Tsai Cheryl J Sickles Rosemarie Mick Selina M Luger David L Porter Patricia A Mangan Lynn M Schuchter Stephen J Schuster Elwyn Y Loh Deborah A Magee Robert A Sachs Mark E Wall Jonni Moore Gordon P Buzby Ellen Zaleta Malek Kamoun Leslie E Silberstein |
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Affiliation: | (1) Bone Marrow and Stem Cell Transplant Program, 16 Penn Tower, University of Pennsylvania Medical Center, 3400 Spruce Stress, 19104 Philadelphia, PA, USA;(2) Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, USA |
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Abstract: | The purpose of this study was to determine the efficacy, engraftment kinetics, effect of bone marrow tumor contamination, and safety of high-dose therapy and granulocyte-colony stimulating factor (G-CSF) mobilized peripheral blood progenitor cell (PBPC) support for patients with responding metastatic breast cancer. Forty two patients underwent G-CSF (10 μg/kg) stimulated PBPC harvest. PBPC and bone marrow aspirates were analyzed by histologic and immunocytochemical methods for tumor contamination. Thirty-seven patients received high-dose therapy consisting of cyclophosphamide 6 g/m2, thiotepa 500 mg/m2, and carboplatin 800 mg/m2 (CTCb) given as an infusion over 4 d followed by PBPC reinfusion and G-CSF (5 μg/kg) support. No transplant related deaths or grade 4 toxicity was recorded. CD34+ cells/kg infused was predictive of neutrophil and platelet recovery. With a median follow-up of 38 months, three year survival was 44% with relapse-free survival of 19%. Histological bone marrow involvement, found in 10 patients, was a negative prognostic factor and was associated with a median relapse-free survival of 3.5 months. Tumor contamination of PBPC by immunohistochemical staining was present in 22.5% of patients and found not to be correlated with decreased survival. G-CSF stimulated PBPC collection followed by a single course of high dose chemotherapy and stem cell infusion with G-CSF stimulated marrow recovery leads to rapid, reliable engraftment with low toxicity and promising outcome in women with responding metastatic breast cancer. |
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Keywords: | metastatic breast cancer bone marrow transplantation tumor contamination |
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