EARLY INTENSIVE AND MYELOABLATIVE ADJUVANT CHEMOTHERAPY IN WOMEN WITHHIGH-RISK BREAST-CANCER

Background: Women with breast cancel and > 10 positive lymph nodes hav e an unfavorable prognosis. The optimal combination and intensity of a djuvant chemotherapy is uncertain. Between July 1994 and December 1996 we treated 19 patients with early intensive followed by high-dose che motherapy and autologous peripheral blood stem cell transplantation. p atients and methods: Patients were initially diagnosed with breast can cer and multiple positive lymph nodes. Induction chemotherapy consiste d of two courses VP16, ifosphamide, cisplatin and epirubicin (VIPE) an d one course of mitoxantrone, cyclophosphamide and thiotepa (MCT). Per ipheral blood stem cells were mobilized after the first or second cour se of VIPE and retransfused two days after high dose chemotherapy. Res ults: Stem cells were successfully collected in all patients. Major to xicities (WHO grade III and IV) were neutropenia, thrombocytopenia, al opecia, nausea, infections and mucositis. Hematopoietic recovery occur red in all patients with a median of 10 days for leukocytes and 13 day s for platelets. No patient died of therapy-induced complications. The median observation time is 24 months. Two patients have relapsed, one with locoregional disease. The projected rate of patients with diseas e-free survival after three years is 88%. Conclusions: Early intensive and myeloablative chemotherapy followed by peripheral blood stem cell transplantation is a highly efficient and feasible protocol for high risk patients with breast cancer.