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11 - Therapeutic decision making in stem cell transplantation for breast cancer

Published online by Cambridge University Press:  31 July 2009

Reinhold Munker
Affiliation:
Louisiana State University
Hillard M. Lazarus
Affiliation:
University Hospitals Case Medical Center
Kerry Atkinson
Affiliation:
University of Queensland
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Summary

The standard of care in the treatment of breast cancer and current recommendations for the diagnosis and treatment of breast cancer can be found in oncology textbooks and the guidelines from the National Comprehensive Cancer Network (www.nccn.org). Because breast cancers are generally sensitive to chemotherapy, it would seem logical that high-dose chemotherapy with stem cell support for metastatic disease would lead to higher remission rates and more durable remissions than those achieved by standard chemotherapy regimens and, in addition, might provide a potential for cure. After the initial optimism and promising findings from pilot and phase II studies, randomized studies were performed to compare high-dose chemotherapy with stem cell support and standard chemotherapy. Now, more than 15 years after the initiation of these studies, little evidence remains to support a role for autologous stem cell transplantation in the treatment of metastatic breast cancer (Vogl et al., 2006). In a 2005 Cochrane review in which six trials comparing high-dose chemotherapy with standard-dose chemotherapy for metastatic breast cancer were analyzed (Farquhar et al., 2005), no statistically significant difference was found in overall survival between the two groups at 1 year, 3 years, or 5 years of follow-up. However, a significant difference in event-free survival, favoring the high-dose group, was found at 1 and 5 years of follow-up. As expected, the toxicity of the treatment was significant in the high-dose chemotherapy group (mainly infections).

Type
Chapter
Information
The BMT Data Book , pp. 165 - 168
Publisher: Cambridge University Press
Print publication year: 2009

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References

Berry, DA, Ueno, NT, Johnson, MM, et al. 2007. High-dose chemotheraphy with autologous stem cell support versus standard dose chemotherapy: meta-analysis of individual patient data from 15 randomized adjuvant breast cancer trials. Breast Canc Treatm Res 106: 51 abstract 11, 5.Google Scholar
Bregni, M, Ueno, NT, Childs, R. 2006. The second international meeting on allogeneic transplantation in solid tumors. Bone Marrow Transplant 38: 527–37.CrossRefGoogle ScholarPubMed
Farquar, C, Marjoribanks, J, Basser, R, et al. 2005. High dose chemotherapy and autologous bone marrow or stem cell transplantation versus conventional chemotherapy for women with metastatic breast cancer (Review). Cochrane Database of Systematic Reviews 3: 1–31.
Nitz, UA, Mohrmann, S, Fischer, J, et al. 2005. Comparison of rapidly cycled tandem high-dose chemotherapy plus peripheral-blood stem-cell support versus dose-dense conventional chemotherapy for adjuvant treatment of high-risk breast cancer: results of a multicentre phase III trial. Lancet 366: 1935–44.CrossRefPubMed
Ueno, NT, Rondon, G, Geisler, D, et al. 1996. Allogeneic blood stem cell transplantation for induction of graft versus tumor effect in patients with metastatic breast cancer. Blood 88;(suppl): 613a (2440).
Vogl, DT and Stadtmauer, EA. 2006. High-dose chemotherapy and autologous hematopoietic stem cell transplantation for metastatic breast cancer. Bone Marr Transpl 37: 985–87.CrossRefGoogle ScholarPubMed

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