High-dose chemotherapy and hematopoietic stem cell rescue for breast cancer: Experience in California

The role of high-dose chemotherapy (HDCT) and autologous hematopoietic stem cell rescue in breast cancer is still controversial. We analyzed the outco mes of 1111 consecutive patients with histologically proven breast cancer w ho underwent HDCT at 5 major California medical centers. The overall treatm ent-related mortality (TRM) was 2.3%. TRM was not influenced by disease sta ge or the HDCT regimen delivered, but it was influenced by hematopoietic gr aft source. The TRM was 6.1% when bone marrow with or without blood stem ce lls was used, but only 1.4% when blood stem cells alone were used (P < .001 ). With a median follow-up of 2.8 years (range, 0.1-8.2 years) after HDCT a nd autologous hematopoietic stem cell rescue, the estimated 5-year event-fr ee survival (EFS) and overall survival (OS) for stage II/IIIA patients with <greater than or equal to>10 involved axillary lymph nodes were 67% and 76 %, respectively. Patients with metastatic breast cancer (MBC) (median follo w-up, 1.9 years [range, 0.03-8.3 years]) achieving a complete response (CR) to conventional-dose chemotherapy or rendered to a "no evidence of disease " status before HDCT had significantly better estimated 5-year EFS and OS ( 28% and 57%, respectively) than those achieving a partial response before H DCT (19% and 27%, respectively; P less than or equal to .0001). Our data su ggest that HDCT with hematopoietic stem cell rescue is safe and can be bene ficial to patients,vith high-risk primary breast cancer and for those with MBC achieving CR/no evidence of disease.