HIGH-DOSE CHEMOTHERAPY CONSOLIDATION WITH AUTOLOGOUS STEM-CELL RESCUEIN METASTATIC BREAST-CANCER - A 10-YEAR EXPERIENCE

One hundred women with metastatic breast cancer (MBC) underwent high-d ose chemotherapy with autologous stem cell rescue at our institution b eginning in 1986, The patients underwent induction chemotherapy from J une 1986 to December 1993. Patients who showed stable or responsive di sease underwent HDC with cyclophosphamide (CY) at 7.5 g/m(2) and thiot epa (TPA) at 675 mg/m(2) or the same doses of CY and TPA with carmusti ne at 450 mg/m(2). The source of stem cell rescue was either BM alone, BM and G-CSF-mobilized peripheral blood progenitor cells (PBPC) or PB PC alone if patients had BM involvement with MBC. With a median follow -up of 62 months (range 1-109 months), median survival from reinfusion was 16 months with a 5-year survival of 19 +/- 4%. The median event-f ree survival (EFS) was 8 months with a 5-year EFS of 11 +/- 3%. Patien ts achieving a complete response to induction therapy showed a higher 5-year EFS from reinfusion of 31 +/- 8% in contrast to 3 +/- 3% (P = 0 .006) for patients who achieved a partial response to induction therap y prior to HDC, narrow involvement or source of stem cell rescue did n ot affect outcome, Our mature results confirm that high-dose chemother apy with autologous stem cell rescue can confer a prolonged DFS in a s ubset of women with MBC. However, the high rate of relapse remains a u niversally disturbing problem in this patient population.