DOSE-INTENSIVE THERAPY WITH AUTOLOGOUS BLOOD STEM-CELL TRANSPLANTATION IN BREAST-CANCER

Background: Breast cancer is the commonest form of cancer in Australia n women. Although approximately 50% of women with breast cancer achiev e long term survival by current management methods, recurrent or metas tatic disease is generally incurable. In addition, women with Stage II disease with > 10 positive axillary lymph nodes and also women with l ocally advanced disease (Stage III) have a poor survival even with adj uvant therapy. Aims: To assess the toxicity and efficacy of high-dose chemotherapy with autologous peripheral blood stem cell (PBSC) transpl antation in women with both metastatic and poor prognosis primary brea st cancer. Methods: Twenty-eight women with either metastatic(15) or p oor prognosis (13) primary breast canter were enrolled in the study be tween November 1988 to January 1993. PBSC were harvested using high-do se cyclophosphamide (Cy) with or without granulocyte-colony stimulatin g factor (G-CSF) and a myeloablative regimen of Cy, melphalan and carb oplatin (CMCp) was used in the transplantation phase. Results: Optimum numbers of stem cells were harvested in 85% of patients. The use of f ive G/m(2) Cy plus G-CSF resulted in better PBSC yields and a signific ant reduction in haematologic morbidity when compared to mobilisation with Cy alone. Twenty-two women underwent 23 PBSC transplants (PBSCT). There have been two early deaths due to sepsis. The predominant morbi dities observed following high dose chemotherapy and transplantation h ave been nausea, mucositis and diarrhoea. The median number of days to discharge following infusion of PBSC was 15 (range 11-21). At a media n follow up time of 1.1 years (range 0 months-3.6 years), 8/22 (36%) e valuable patients remain alive and disease free while 14/22 (64%) have relapsed or progressed or died. Conclusion: High-dose chemotherapy an d autologous PBSCT is a potentially highly effective treatment of wome n with metastatic and poor prognosis primary breast cancer. Randomised studies are required to compare this form of therapy to more standard forms of treatment in breast cancer.