HIGH-DOSE CHEMOTHERAPY WITH AUTOLOGOUS HEMATOPOIETIC PROGENITOR-CELL SUPPORT AS PART OF COMBINED-MODALITY THERAPY INPATIENTS WITH INFLAMMATORY BREAST-CANCER

Purpose: To evaluate the feasibility of high-dose chemotherapy (HDC) w ith autologous hematopoietic progenitor-cell support (AHPCS) as part o f combined modality therapy (CMT) in patients with inflammatory breast cancer (IBC). Patients and Methods: From April 1993 to March 1997, 30 patients with IBC were treated at our program. Twenty-three patients received neoadjuvant chemotherapy (NAC) before HDC; 18 patients also r eceived adjuvant chemotherapy following surgery, but before Hoc. All p atients received Hoc with high-dose cyclophosphamide, cisplatin, and c armustine (BCNU) with AHPCS. Every patient underwent surgery either be fore (27 patients) or after (three patients) Hoc. Patients received ra diotherapy after HDC in addition to tamoxifen if their tumors were est rogen receptor-positive. Results: Thirteen patients experienced grade 3 or 4 nonhematologic noninfectious toxicities. In 12 patients (40%), this represented drug-induced lung injury, which in all cases responde d to a 10-week course of corticosteroids. The only treatment-related d eath wets secondary to hemolytic-uremic syndrome (HUS). Another patien t suffered grade 4 CNS toxicity, which was completely reversible. All patients engrafted promptly. Eight patients relapsed, five of whom had a poor pathologic response to NAG. Relapses were local (five patients ), local plus systemic (one), or systemic only (two). Median follow-up time from diagnosis and HDC is 23.5 (range, 7 to 49) and 19 (range, 4 to 44) months, respectively. Twenty-one patients (70%; 95% confidence interval [CI], 51% to 86%) remain alive and free of disease 4 to 44 m onths after HDC. Median disease-free survival (DFS) and overall surviv al have not yet been reached. Conclusion: HDC as part of CMT is feasib le in patients with lee. The toxicity of this treatment program is sig nificant, but tolerable. Despite the short follow-up duration, the pro mising DFS observed in this group of patients warrants randomized stud ies that include; a Hoc-containing arm in patients with IBC. (C) 1998 by American Society of Clinical Oncology.