1125 High-dose therapy with hemopoietic stem cell support for high risk breast cancer. A pilot study in 31 patients

Abstract

From February 1992 to August 1994 31 women with high risk breast cancer received high dose cyclophosphamide (1.5g/m²×4 days), carboplatin (200mg/m²×4 days continuous infusion) and thiotepa (125mg/m²/4 days, continuous infusion) as intensification treatment after conventional adjuvant chemotherapy. Median age was 43 years (27–61). Bone marrow was employed as source of stem-cell support in 22 patients and G-CSF mobilized peripheral stem cell in the rest 9 patients. G-CSF as a dose of 5 mcg/kg/day was administered in all bone marrow transplant patients until neutrophil engraftment. No toxic death occurred and major toxicities were as follows: neutropenic fever (31/31), grade II and III mucositis (5), grade II and III gastrointestinal toxicity (6), mild hemorrhagic cystitis (2), pulmonary embolism (1), post-transfusional hepatitis (1), grade II cardiac toxicity (1), pulmonary hemorrhage (1). Median days to reach neutrophil (>500/mm³) and platelet engraftment (>25000) were 12 (9–30) and 18 (9–34) respectively. Median days of hospitalization were 24 (19–42), and for intravenous antibiotics 12 days (5–23). Red packed cells and platelets requirements were 4 (0–7) and 42 (6–141) respectively. There were no difference in terms of engraftment, days of antibiotics, transfusion requirements, use of antifungal therapy, time of hospitalization between patients that received bone marrow or peripheral blood stem cells as blood support. Nevertheless a trend for a lower value in all these variables was observed for peripheral stem cell. With a median follow-up of 12 months (3–31) four patients relapsed on days 113, 206, 248, 374 after transplant. Disease-free survival at 2 years is 72%. Three out of four relapsed patients died. Multiple metastatic sites at relapse occurred in 3 patients (liver: 2, skin: 1, pleural 2, pulmonary 2, nodes: 1). A poor response to salvage chemotherapy with a rapid progression and death occurred in three patients.