Factors correlated with progression-free survival after high-dose chemotherapy and hematopoietic stem cell transplantation for metastatic breast cancer

Context Women with breast cancer are the most frequent recipients of high-d ose chemotherapy followed by autologous hematopoietic stem cell transplanta tion (autotransplants) in North America. Despite widespread use, controvers y exists about the benefits of and appropriate patients for this therapy. Objective To determine factors associated with disease progression or death after autotransplantation in women with metastatic breast cancer. Design Analysis of data collected retrospectively (January 1989 to 1992) an d prospectively (1992 through January 1995) for the Autologous Blood and Ma rrow Transplant Registry. Setting Sixty-three hospitals in North America, Brazil, and Russia. Participants A total of 1188 consecutive women aged 18 to 70 years receivin g autotransplants for metastatic or locally recurrent breast cancer, with a median follow-up of 29 1/2 months. Main Outcome Measure Time to treatment failure (disease progression, diseas e recurrence, or death) after autotransplantation. Results Factors associated with significantly (P<.05) increased risk of tre atment failure in a Cox multivariate analysis included age older than 45 ye ars (relative hazard, 1.17; 95% confidence interval [CI], 1.02-1.33), Karno fsky performance score less than 90% (1.27; 95% CI, 1.07-1.51), absence of hormone receptors (1.31; 95% CI, 1.15-1.51), prior use of adjuvant chemothe rapy (1.31; 95% CI, 1.10-1.56), initial disease-free survival interval afte r adjuvant treatment of no more than 18 months (1.99; 95% CI, 1.62-2.43), m etastases in the liver (1.47; 95% CI, 1.20-1.80) or central nervous system (1.56; 95% CI, 0.99-2.46 [approaches significance]) vs soft tissue, bone, o r lung, 3 or more sites of metastatic disease (1.32; 95% CI, 1.13-1.54), an d incomplete response vs complete response to standard-dose chemotherapy (1 .65; 95% CI, 1.36-1.99). Receiving tamoxifen posttransplantation was associ ated with a reduced risk of treatment failure in women with hormone recepto r-positive tumors (relative hazard, 0.60; 95% CI, 0.47-0.87). Women with no risk factors (n = 38) had a 3-year probability of progression-free surviva l of 43% (95% CI, 27%-61%) vs 4% (95% CI, 2%-8%) for women with more than 3 risk factors (n = 343), Conclusion These data indicate that some women are unlikely to benefit from autotransplantation and should receive this treatment only after being pro vided with prognostic information and in the context of clinical trials att empting to improve outcome.