[高剂量化疗及外周造血祖细胞自体移植治疗乳腺癌：初步结果、毒性分析及必要的支持手段]

[High-dosage chemotherapy and the autologous transplantation of peripheral hematopoietic progenitor cells in breast cancer: the initial results, analysis of toxicity and the necessary support means].

作者信息

Sola Rocabert C, Mesía R, Mendoza L, Tabernero J M, Amill B, Maroto P, Bellet M, Ojeda B, Alonso M C, Verger G

机构信息

Departamento de Oncología, Hospital de la Santa Creu i Sant Pau, Barcelona.

出版信息

Med Clin (Barc). 1995 Oct 7;105(11):407-11.

PMID:7475451

Abstract

BACKGROUND

In the last years high dose chemotherapy (HDC) schedules have been developed with autologous bone marrow transplantation (ABMT) which are very effective in breast cancer. Expectation has been raised concerning the cure of a subgroup of patients with metastatic breast cancer and the improvement of prognosis in high risk stages II and III.

METHODS

CTCb (cyclophosphamide 6 g/m2, thiotepa 500 mg/m2 and carboplatin 800 mg/m2) was administered with autologous peripheral hematopoietic progenitor cells transplantation (TACPHP) and granulocytic colony stimulating factor (G-CSF) 5 micrograms/kg/day to 27 patients with breast cancer: 9 in stage IV in complete remission, 12 in stage II with > or = 10 affected lymph nodes and 6 in stage III.

RESULTS

No toxic deaths were reported. The median time to achieve > or = 0.5 x 10(9) neutrophils/l was 8 days, to > or = 20 x 10(9) platelets/l 9 days and to > or = 50 x 10(9) platelets/l 12 days. Fever was observed in 85% of the patients although its median duration was of only one day. Extrahematologic toxicity was moderate with grade III nausea/vomiting in 48% of patients, grade III mucositis in 22%, grade III hepatitis in 19%, and grade III diarrhea in 4%. No grade IV toxicity was observed. The median follow-up is still short (10 months, range: 2-25). All the patients maintain normal hematologic peripheral blood counts and only 4 (in stage IV) have relapsed.

CONCLUSIONS

The slight extrahematologic toxicity observed in the high dose chemotherapy with cyclophosphamide, thiotepa and carboplatin, and the rapid hematologic recovery provided by the TACPHP and G-CSF allow the above schedule to be administered with moderate toxicity and no mortality. This low toxic profile leads to the possibility of future trials with this chemotherapy schedule in other subgroups of patients with breast cancer.

摘要

背景

近年来，已研发出联合自体骨髓移植（ABMT）的大剂量化疗（HDC）方案，该方案在乳腺癌治疗中非常有效。对于转移性乳腺癌亚组患者的治愈以及高危II期和III期患者预后的改善，人们的期望有所提高。

方法

对27例乳腺癌患者给予环磷酰胺6 g/m²、噻替派500 mg/m²和卡铂800 mg/m²（CTCb）联合自体外周造血祖细胞移植（TACPHP）以及粒细胞集落刺激因子（G-CSF）5微克/千克/天：9例IV期患者处于完全缓解期，12例II期患者有≥10个受累淋巴结，6例III期患者。

结果

未报告有因毒性导致的死亡。达到≥0.5×10⁹中性粒细胞/升的中位时间为8天，达到≥20×10⁹血小板/升的中位时间为9天，达到≥50×10⁹血小板/升的中位时间为12天。85%的患者出现发热，但其中位持续时间仅为1天。血液学外毒性为中度，48%的患者出现III级恶心/呕吐，22%出现III级黏膜炎，19%出现III级肝炎，4%出现III级腹泻。未观察到IV级毒性。中位随访时间仍然较短（10个月，范围：2 - 25个月）。所有患者外周血细胞计数维持正常，仅4例（IV期）复发。