High-dose chemotherapy and stem cell transplantation for patients with stage IV breast cancer without clinically evident disease: correlation of CD34+ selection to clinical outcome

Abstract

Summary:Forty-five patients with metastatic breast cancer without clinically evident disease were treated with thiotepa 750 mg/m 2 , mitoxantrone 40 mg/m 2 and carboplatin 1000 mg/m 2 followed by stem cell transplantation to determine the safety and efficacy of CD34 + selection of peripheral blood stem cells. Of these, 15 patients' (group I) stem cells were processed through Baxter Isolex 300 device for CD34 + selection, whereas 30 patients (group II) received unmanipulated stem cells. Toxicity, progression-free survival and survival were compared between these two groups. There was no difference in transfusion requirements, white cell count and platelet recovery and non-hematologic toxicity between the two groups. The survival of patients in group I was 27 months compared to 38 months in group II (P = 0.8). The progression-free survival was 12 months and 13.5 months for group I and group II patients, respectively (P = 0.6). Our results indicate that while there is no adverse effect, there is also no significant advantage of CD34 + selection in terms of progression-free survival and survival in patients with metastatic breast cancer without clinically evident disease. Bone Marrow Transplantation (2000) 25, 1041-1045. Keywords: CD34 + selection; PBSC transplantation; metastatic breast cancer High-dose chemotherapy (HDC) with peripheral blood stem cell (PBSC) transplantation has been shown to be effective in patients with metastatic carcinoma of the breast. [1][2][3][4] In patients who achieve a complete remission with chemotherapy, long-term disease-free survival can be obtained by a variety of different HDC regimens. 1,2,5,6 The use of high-dose chemotherapy with stem cell rescue has allowed dose-intensity to be maximized and morbidity and mortality to be reduced. In fact, in most series, peri-transplant mortality now is below 5%. 4,7 This has allowed wide- [12][13][14] In order to reduce the risk of relapse due to tumor cells in the PBSC preparation, a variety of techniques has been applied. Negative selection techniques using chemotherapeutic agents or monoclonal antibodies have been shown to deplete tumor cells by 3 logs. 15,16 Selection techniques that enrich the preparation with CD34 + cells and deplete tumor cells in the PBSC preparation have also been used. [17][18][19] We investigated the use of CD34 + selection in patients with metastatic breast cancer undergoing HDC with PBSC, and compared the results to those noted in other patients with metastatic breast cancer undergoing identical conditioning and post-transplant care whose stem cell product was not CD34 + selected. Materials and methods Patient selectionForty-five consecutive patients with metastatic breast cancer that had been rendered free of clinically evident disease by using chemotherapy only or in combination with surgery, radiation or hormonal manipulations were eligible for PBSC transplantation following dose-intensive therapy.Patients were required to have histological documentation of breast cancer, age over 18 years, performance status...

High-dose chemotherapy and CD34-selected peripheral blood progenitor cell transplantation for patients with breast cancer metastatic to bone and/or bone marrow

“…A number of randomized studies comparing the hematopoietic recovery in CD34-selected vs non-selected autologous transplant found no significant delay in recovery of neutrophils or platelets in the CD34-selected recipients. 12,24,25 Our study found a median ANC recovery time of 9 days, with median time to platelet transfusion independence of 12 days, which is in agreement with previous trials. The use of the CD34-selected PBPC did not have any deleterious effect on the outpatient transplant approach in our study.…”

“…Other studies have looked at this in small groups of patients who received either CD34-selected PBPC or unmodified PBPC transplants. 24,25 In the study of Ahmed et al, 24 15 patients received CD34-selected stem cells and 30 patients received unmanipulated stem cells for stage IV breast cancer. They found no difference in the median overall and progression-free survivals.…”

High-dose therapy in patients with Hodgkin's disease: the use of selected CD34+ cells is as safe as unmanipulated peripheral blood progenitor cells

“…[31][32][33] We observed a fast haematological engraftment in all patients after reinfusion with a median number of 5.8 × 10 6 CD34 + cells/kg in the CD34 + group and 4.5 × 10 6 in the PBPC group. In addition, the engraftment data indicate that G-CSF is not necessary after HDT when a satisfactory number of CD34 + cells are reinfused.…”