The High Dose Chemotherapy and Autologous Peripheral Blood Stem CEll Transplantation in High Risk and Metastatic Breast Cancer Patients

Abstract

It is widely accepted that node-positive breast cancer patients should receive adjuvant chemotherapy or hormonal therapy following definitive surgery. While significant changes have been made in the care of breast cancer patients over the last 20 years, particularly with regard to surgical management of adjuvant therapy, long term prognosis remians poor for patients with 10 or more involved axillary nodes(high risk for relapse group) and is dismal for patients with stage Ⅳ disease following conventional dose chemotherapy.

We investigated the outcomes of 28 patients with breast cancer undergoing chemo-mobilization of peripheral blood stem cells (PBSC) and high dose chemotherapy (HDCT) with PBSC transplantation. 28 patients with a median age of 44 years (range 30-58 years) were entered to our study, three of them received HDCT twice because of residual after first HDCT. We divided the patients into three groups consisting of (1) six patients with 10 or more node positive as a high risk group, (2) 11 relapsed patients

who responded to conventional chemotherapy as a sensitive relapsed group, (3) 11

relapsed patients who did not respond to conventional chemotherapy as a refractory

relapsed group. Mean follow-up duration was 16.5 months (range 1-36 months).

Pre-mobilization chemotherapy included FEC regimen (5-FU 600 ㎎/㎡, Epirubicin 60 ㎎/

㎡, cyclophosphamide 600 ㎎/㎡×3 or 6 cycles) in 15 patients, Paclitaxel with

Carboplatin regimen (Taxol 160 ㎎/㎡, Carboplatin 300 ㎎/㎡×3 cycles) in 4 patients, anthracycline containing regimen in eight patients. We collected autologous stem cells from G-CSF primed peripheral blood after conventional chemotherapy. Mean

mononuclear cell(MNC) count was 3.4±1.1×108/㎏, CD34+ was 7.6±5.0×106/㎏, CFU-GM was 1.8±2.1×105/㎏. All of the patients engarfted at mean data of 11.1 days after transplantation(median 9 days).

As the high dose chemotherapy, 22 patients received CBP regimen(Cyclophosphamide

6g/㎡, BCNU 400 ㎎/㎡, Cisplatin 165 ㎎/㎡), there patients ICE regimen (Ifosphamide 8

g/㎡, Carboplatin 1.2g/㎡, Etoposide 600 ㎎/㎡), six patients ML regimen (Mitoxantrone

75 ㎎/㎡, Melphalan 180㎎/㎡). Treatment-related mortality(TRM) was developed in five

patients(one due to VOD, four due to sepsis). Diffuse alveolar damage was developed in three patients, and Herpes Zoster in fection was developed in six patients.

Overall survival (OS) rate of all patients was 56.5%(high risk group 100%, sensitive

relapsed group 58.9%, refractory relapsed group 36.4%). Disease free survival (DFS) rate of high risk group was 55.5% with 26 months of mean DFS duration. Progression free survival(PFS) rate of sensitive relapsed group was 25.2% with 20 months of median PFS duration. PFS rate of refractory relapsed group was 25% with 8 months of meidian PFS duration.