Department of Hematology/Oncology, Eberhard Karls University, Otfried-Mueller-Str. 10, D-72076 Tuebingen, Germany.
Anticancer Res. 2011 Nov;31(11):4025-30.
In contrast to marrow micrometastasis, development of symptomatic bone marrow involvement (bone marrow carcinomatosis, BMC) is a rare event in the course of metastatic breast cancer; published evidence on the outcome with systemic treatment is even more scarce. The objective of this study was to provide our institution's experience with the clinical presentation, prognosis, treatment, and associated complications of marrow involvement in breast cancer.
Twenty-two breast cancer patients with BMC diagnosed between 1995 and 2009 were analyzed.
All patients presented with osseous metastases at the time of diagnosis of BMC. Anemia was the most prominent hematologic sign present in 17/22, followed by thrombocytopenia. Cytotoxic treatment was offered to 21/22 of patients. The majority showed an improvement of cytopenia following treatment (10 out of 14 anemic patients, 6 out of 9 thrombocytopenic patients, all 4 leukopenic patients). The complication rate was acceptable, with only 5 grade 3 or 4 events related to cytopenia (febrile neutropenia, bleeding). The estimated median overall survival from the date of BMC diagnosis was 19 months. After 4 years, 4 of the patients were still alive. Interestingly, prognosis from the time of first diagnosis of BMC was independent of the duration of metastatic disease before BMC had been diagnosed.
Bone marrow involvement has to be considered in breast cancer patients, in particular in those with bone metastases and otherwise unexplained cytopenia. The peripheral blood smear can serve as a simple diagnostic tool, but the extent of erythroblastosis is not correlated with survival. Even with severe BMC-associated cytopenia, aggressive combination treatment regimens are indicated, since most patients show improved marrow function after chemotherapy and long-lasting survival is possible.
与骨髓微转移相反，在转移性乳腺癌的发展过程中，出现有症状的骨髓受累（骨髓转移癌，BMC）是一种罕见事件；关于系统治疗的结果的已有文献证据更为稀少。本研究的目的是提供我们机构在乳腺癌骨髓受累的临床表现、预后、治疗和相关并发症方面的经验。
分析了 1995 年至 2009 年间诊断为 BMC 的 22 例乳腺癌患者。
所有患者在诊断 BMC 时均出现骨转移。贫血是最突出的血液学表现，见于 22 例中的 17 例，其次是血小板减少症。21/22 的患者接受了细胞毒性治疗。大多数患者在治疗后血细胞减少症得到改善（14 例贫血患者中的 10 例，9 例血小板减少症患者中的 6 例，所有 4 例白细胞减少症患者）。并发症发生率可以接受，只有 5 例与血细胞减少症相关的 3 或 4 级事件（发热性中性粒细胞减少症、出血）。从 BMC 诊断日期开始的估计中位总生存期为 19 个月。4 年后，4 例患者仍存活。有趣的是，从 BMC 首次诊断开始的预后与 BMC 诊断前转移性疾病的持续时间无关。
在乳腺癌患者中，特别是在有骨转移且无其他原因的血细胞减少症的患者中，必须考虑骨髓受累。外周血涂片可作为一种简单的诊断工具，但网织红细胞增多症的程度与生存无关。即使存在严重的 BMC 相关血细胞减少症，也需要使用积极的联合治疗方案，因为大多数患者在化疗后骨髓功能得到改善，并且可以实现长期生存。
