[High-dose chemotherapy and stem-cell in patients with breast cancer]

The treatment of breast cancer patients with high-dose chemotherapy and stem-cell support is still highly controversial. The elucidation of its clinical benefit awaits the maturation of on-going clinical trials.

Patients with chemotherapy-sensitive metastatic or locally advanced disease and patients with stage II/III disease and at least four positive axillary lymph nodes in the initial surgical specimen were eligible for transplantation.

Fifty-five women underwent transplantation between 1994 and 2000. For the 19 women with metastatic disease, the median time to progression was seven month and survival 28 months. Only two patients are progression-free, at 48 and 77 months, both with supraclavicular and/or cervical lymph node-only disease. For the 36 women with stage II/III disease, the median time to progression and survival were both 65 months -19 are alive, 18 disease-free. Among the subgroup of 23 patients with 10 or more positive axillary nodes, the five-year event-free survival was 57%.

The clinical benefit of stem-cell transplantation for metastatic breast cancer is limited since the time to progression and survival after transplantation is similar to those reported in patients with newly diagnosed metastases and treated with conventional-dose chemotherapy. However, in patients with high-risk stage II/III disease the time to progression is longer than that reported for similar patients treated with conventional systemic treatment. These results are similar to previous reports in the literature.