Autologous bone marrow transplantation in metastatic breast cancer

The use of adjuvant chemotherapy following the primary treatment of breast cancer has led to an increased disease-free survival. The outlook for patients who present with metastatic disease however remains dismal, with little improvement in survival in the last decade. A recent analysis by Bonadonna and his colleagues has demonstrated a strong influence of the dose of drugs administered on relapse-free survival in patients with breast cancer receiving adjuvant therapy and those with metastatic disease. The utilization of cryopreserved autologous bone marrow permits the use of more aggressive therapy without regard to marrow toxicity, the dose-limiting feature of many antineoplastic agents. Some of the questions and potential problems with the use of autologous marrow rescue in solid tumors is discussed. Preliminary data on a protocol to evaluate the role of high-dose cyclophosphamide and total body irradiation with autologous marrow transplantation in patients with metastatic breast carcinoma are presented.