Bashey A, Corringham S, Garrett J, Lane T A, Gilpin E A, Corringham R E, Law P, Ho A D
Blood and Marrow Transplantation Program, University of California, San Diego, La Jolla, CA 92093-7621, USA.
Bone Marrow Transplant. 2000 Mar;25(5):519-24. doi: 10.1038/sj.bmt.1702172.
Multi-cycle high-dose chemotherapy with autologous stem cell support (HDC-ASCS) may improve the results obtained with single-cycle HDC-ASCS in metastatic breast cancer (MBC). However, the tolerability and efficacy of additional cycles of HDC-ASCS in patients selected using standard eligibility criteria for single cycle HDC-ASCS is uncertain. Twenty-nine patients with MBC and a CR or PR to induction chemotherapy were selected by standard institutional eligibility criteria for single-cycle HDC-ASCS. Cycle 1 HDC-ASCS (cyclophosphamide 6 g/m2; mitoxantrone 70 mg/m2; carboplatin 800 mg/m2) was followed by a planned second cycle (etoposide 1.6 g/m2; thiotepa 800 mg/m2; carboplatin 800 mg/m2 modulated by tamoxifen 120 mg/m2/day x 5 days) with a median interval of 3.2 months. CR rate was 20% after induction chemotherapy and 33% and 54% after HDC cycles I and II, respectively. Sixteen patients (55%) failed to complete HDC cycle II within 200 days because of disease progression, toxicity, inadequate stem cell collection, insurance denials or patient choice. Median progression-free survival (PFS) for all 29 patients entered is 301 days from date of HDC cycle I and actuarial PFS at 2 years is 35%. For the 13 patients who received the two cycles of HDC-ASCS, actuarial PFS at 2 years was 54% (P = NS compared to those receiving only one cycle). These data show that a second cycle of full-dose intensity HDC-ASCS may increase the proportion of patients with MBC that achieve CR and may increase PFS. However, a large proportion of patients that complete HDC-ASCS cycle I may fail to proceed to cycle II in a timely fashion. Bone Marrow Transplantation (2000) 25, 519-524.
多周期高剂量化疗联合自体干细胞支持（HDC - ASCS）可能会改善转移性乳腺癌（MBC）单周期HDC - ASCS的治疗效果。然而，对于使用单周期HDC - ASCS标准入选标准所选择的患者，额外周期的HDC - ASCS的耐受性和疗效尚不确定。29例对诱导化疗达到完全缓解（CR）或部分缓解（PR）的MBC患者，通过单周期HDC - ASCS的标准机构入选标准进行选择。第1周期HDC - ASCS（环磷酰胺6 g/m²；米托蒽醌70 mg/m²；卡铂800 mg/m²）之后计划进行第2周期（依托泊苷1.6 g/m²；噻替派800 mg/m²；卡铂800 mg/m²，由他莫昔芬120 mg/m²/天×5天进行调整），中位间隔时间为3.2个月。诱导化疗后的CR率为20%，HDC第1周期和第2周期后的CR率分别为33%和54%。16例患者（55%）由于疾病进展、毒性、干细胞采集不足、保险拒绝或患者选择等原因，未能在200天内完成HDC第2周期。所有入组的29例患者从HDC第1周期开始计算的中位无进展生存期（PFS）为301天，2年的精算PFS为35%。对于接受两个周期HDC - ASCS的13例患者，2年的精算PFS为54%（与仅接受一个周期的患者相比，P =无显著性差异）。这些数据表明，全剂量强度的HDC - ASCS第2周期可能会增加达到CR的MBC患者比例，并可能增加PFS。然而，很大一部分完成HDC - ASCS第1周期的患者可能无法及时进入第2周期。《骨髓移植》（2000年）25卷，519 - 524页 。
