High-dose chemotherapy with peripheral blood stem cell support for stage IIIB inflammatory carcinoma of the breast

The purpose of this study was to determine outcomes for 56 patients with in flammatory breast cancer (IBC) receiving high-dose chemotherapy (HDC) with cyclophosphamide, thiotepa and carboplatin (CTCb) with peripheral blood ste m cell (PBSC) support. All patients received the same total amount of chemo therapy but there were differences in the sequence of therapy: 15 received induction chemotherapy, chemotherapy mobilization of PBSC: and CTCb after s urgery (adjuvant group) while II received induction chemotherapy with (n = 17) or without (n = 24) chemotherapy for mobilization of PBSC prior to surg ery and CTCb after surgery (neoadjuvant group). Median time from diagnosis to HDC was 5.5 months (range 3.5-12.5). Fifty-one patients (91%) required a dmission to the hospital following HDC for a median of 11 days (range 5-25) . There were two (4%) infectious deaths after HDC. Twenty-four patients (43 %) have relapsed at a median of 18 months (range 8-50) from diagnosis resul ting in death in 34%. The probabilities of overall (OS) and event-free surv ival (EFS) at 3 years for all 56 patients were 0.72 and 0.53, respectively, with a median followup of 44 months (range 15-76) from diagnosis. There we re no differences in OS, EFS or patterns of relapse between patients in the adjuvant or neoadjuvant groups. These sequences of combined modality thera py incorporating HDC are comparable or superior to other intensive approach es for the treatment of IBC. Further improvements will be necessary to decr ease systemic recurrences.