Pittman K B, To L B, Bayly J L, Olweny C L, Abdi E A, Carter M L, Malycha P, Gill P G, Walsh J, Ward G G
Clinical Haematology and Bone Marrow Transplantation Unit, Royal Adelaide Hospital, Australia.
Bone Marrow Transplant. 1992 Dec;10(6):535-40.
A programme of repeated high dose chemotherapy for advanced breast cancer was developed using (1) cyclophosphamide 4 g/m2 followed by autologous peripheral blood stem cell (PBSC) collection; (2) three cycles of conventional dose chemotherapy; (3) high dose cyclophosphamide, cisplatin, and carmustine with PBSC rescue; and (4) high dose etoposide and melphalan with PBSC rescue. Fifteen eligible patients had advanced poor prognosis breast cancer either at initial diagnosis (one patient) or at relapse (14 patients). During the course of the protocol, there were three treatment related deaths, two patient withdrawals due to debilitating toxicity, five patient withdrawals due to disease progression, and one patient withdrawal due to inadequate collection of PBSC. The remaining four patients did not complete the planned protocol as the programme was terminated because of the unacceptable morbidity and mortality. They were treated with an alternative high dose chemotherapy protocol which was well tolerated. This study highlights the significant problems associated with a complex sequential high dose chemotherapy regimen. Cyclophosphamide mobilized PBSC infused following high dose chemotherapy enables rapid haematological recovery. However the non-haematological toxicity following high dose chemotherapy regimens is often severe and may limit the application of certain sequential high dose chemotherapy combinations in patients with breast cancer.
针对晚期乳腺癌，制定了一项重复高剂量化疗方案，具体如下：（1）环磷酰胺4 g/m²，随后采集自体外周血干细胞（PBSC）；（2）三个周期的常规剂量化疗；（3）高剂量环磷酰胺、顺铂和卡莫司汀，并进行PBSC解救；（4）高剂量依托泊苷和美法仑，并进行PBSC解救。15名符合条件的患者患有晚期预后不良乳腺癌，其中1例为初诊时患病，14例为复发时患病。在该方案实施过程中，有3例与治疗相关的死亡，2例因严重毒性反应而退出治疗，5例因疾病进展而退出治疗，1例因PBSC采集不足而退出治疗。由于发病率和死亡率过高，该方案终止，其余4例患者未完成计划方案，转而接受了耐受性良好的替代高剂量化疗方案治疗。本研究突出了与复杂的序贯高剂量化疗方案相关的重大问题。高剂量化疗后输注环磷酰胺动员的PBSC可实现快速血液学恢复。然而，高剂量化疗方案后的非血液学毒性往往很严重，可能会限制某些序贯高剂量化疗组合在乳腺癌患者中的应用。
