Martino Massimo, Lanza Francesco, Pavesi Lorenzo, Öztürk Mustafa, Blaise Didier, Leno Núñez Rubén, Schouten Harry C, Bosi Alberto, De Giorgi Ugo, Generali Daniele, Rosti Giovanni, Necchi Andrea, Ravelli Andrea, Bengala Carmelo, Badoglio Manuela, Pedrazzoli Paolo, Bregni Marco
Hematology and Stem Cell Transplant Unit, Azienda Ospedaliera BMM, Reggio Calabria, Italy.
Section of Hematology and Bone Marrow Transplant Unit, AO Isituti Ospitalieri di Cremona, Cremona, Italy.
Biol Blood Marrow Transplant. 2016 Mar;22(3):475-81. doi: 10.1016/j.bbmt.2015.12.011. Epub 2015 Dec 23.
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.
这项回顾性研究的目的是评估1995年至2005年间在欧洲接受移植的583例高危乳腺癌（BC）患者（>3个阳性淋巴结）中辅助大剂量化疗（HDC）和自体造血干细胞移植（AHSCT）的毒性和疗效。所有患者在移植前均接受了手术，55例患者（9.5%）在手术前接受了新辅助治疗。中位年龄为47.1岁，57.3%的患者在治疗时处于绝经前，56.5%的患者患有内分泌反应性肿瘤，19.5%的患者患有人类表皮生长因子受体2（HER2）阴性肿瘤，72.4%的患者在手术时有≥10个阳性淋巴结。79%的患者接受了单次HDC治疗。总体移植相关死亡率为1.9%，2001年至2005年间为0.9%，而继发性肿瘤相关死亡率为0.9%。中位随访120个月，整个人群5年和10年的总生存率和无病生存率分别为75%和64%以及58%和44%。亚组分析表明，内分泌反应性肿瘤、阳性淋巴结<10个和肿瘤较小的患者的总生存率明显更好。HER2状态不影响生存概率。辅助HDC联合AHSCT在高危BC患者中的死亡率较低，并提供了令人印象深刻的长期生存率。我们的结果表明，这种治疗方式应在选定的高危BC患者中考虑，并在临床试验中进一步研究。
