High-Dose Chemotherapy and Autologous Hematopoietic Stem Cell Transplantation as Adjuvant Treatment in High-Risk Breast Cancer: Data from the European Group for Blood and Marrow Transplantation Registry

Abstract

The aim of this retrospective study was to assess toxicity and efficacy of adjuvant high-dose chemotherapy (HDC) and autologous hematopoietic stem cell transplantation (AHSCT) in 583 high-risk breast cancer (BC) patients (>3 positive nodes) who were transplanted between 1995 and 2005 in Europe. All patients received surgery before transplant, and 55 patients (9.5%) received neoadjuvant treatment before surgery. Median age was 47.1 years, 57.3% of patients were premenopausal at treatment, 56.5% had endocrine-responsive tumors, 19.5% had a human epidermal growth factor receptor 2 (HER2)-negative tumor, and 72.4% had ≥10 positive lymph nodes at surgery. Seventy-nine percent received a single HDC procedure. Overall transplant-related mortality was 1.9%, at .9% between 2001 and 2005, whereas secondary tumor-related mortality was .9%. With a median follow-up of 120 months, overall survival and disease-free survival rates at 5 and 10 years in the whole population were 75% and 64% and 58% and 44%, respectively. Subgroup analysis demonstrated that rates of overall survival were significantly better in patients with endocrine-responsive tumors, <10 positive lymph nodes, and smaller tumor size. HER2 status did not affect survival probability. Adjuvant HDC with AHSCT has a low mortality rate and provides impressive long-term survival rates in patients with high-risk BC. Our results suggest that this treatment modality should be considered in selected high-risk BC patients and further investigated in clinical trials.

High-Dose Chemotherapy and Autologous Stem Cell Transplantation in Breast Cancer: Is There Still a Hope?

“…12,13 Recently, Martino et al in an EBMT retrospective analysis, showed that adjuvant HDC with ASCT, in contrast with early studies 14,15 , is a safe procedure with a TRM (Transplant related mortality) that is, in more recent years, less than 1%. 16 This is consistent with what has been observed in modern prospective studies. 17,18 Furthermore, in keeping with previous reports [19][20][21] , the long-term effects of HDC do not differ from those observed with conventional chemotherapy, in particular regarding the risk of secondary cancer.…”

“…The metastatic potential in TN BC is similar to that of other BC subtypes, but these tumors are associated with a shorter median time to relapse and death, as is also demonstrated in the small cohort of patients included by Martino et al in the EBMT retrospective analysis. 16 While only 27% of pts had HER2 status available, Berry et al conducted an additional (questionable) statistical evaluation, not often utilized in medical oncology, and conclude that "the triple-negative observation is likely to be spurious". 19 A positive effect of HDC in HER2-negative population, particularly in triple-negative tumors, is biologically plausible and supported by clinical evidence.…”

Indications for haematopoietic cell transplantation for haematological diseases, solid tumours and immune disorders: current practice in Europe, 2022

“…As discussed in more detail in previous reports [111,194], the overall conclusion is that auto-HCT in BC improves PFS but not OS in most studies. However, auto-HCT may still represent a clinical option for selected patients with specific biological characteristics and/or having gross involvement of axillary nodes (adjuvant setting) or highly chemosensitive disease (advanced setting) [195][196][197][198][199].…”

Highly favorable outcome in BRCA-mutated metastatic breast cancer patients receiving high-dose chemotherapy and autologous hematopoietic stem cell transplantation

“…Recent studies suggested a role for HDC and HDC-AHSCT in the context of BC, also in view of the fact that this procedure can now be given safely, but failed to clearly identify the subset of patients who may benefit from HDC AHSCT. [7][8][9] We hypothesized that HDC AHSCT might be particularly beneficial to patients with BRCA genetic inactivation. Thus, we conducted a retrospective study focusing on metastatic breast cancer (MBC) patients receiving HDC AHSCT with the objective to examine the outcome of patients according to the presence of a documented germline BRCA mutation status.…”