Saez R A, Selby G B, Slease R B, Epstein R B, Mandanas R A, Confer D L
University of Oklahoma Health Sciences Center, Oklahoma City 73190.
J Okla State Med Assoc. 1994 Sep;87(9):405-10.
Metastatic breast cancer accounts for 18% of cancer deaths among women in the U.S. Conventional combination chemotherapy produces responses in 50% to 80% of women with metastatic breast cancer, but is never curative. A major medical center administered high-dose chemotherapy and autologous bone marrow transplantation to 68 women with metastatic breast cancer between 1983 and 1993. Forty-nine of these women had estrogen receptor-negative tumors, a poor prognostic sign. Eighteen women with estrogen receptor-positive tumors had failed prior hormonal manipulation or had metastatic breast cancer at initial diagnosis. Prior to transplantation, 37 women were in first complete or partial remission, 8 were in their second complete or partial remission, 4 had stable disease, 14 had progressive disease, and 5 were in untreated relapse. Bone marrow transplantation preparatory regimens included high doses of single agents or combination chemotherapy. Among women not in remission before transplantation, 71% entered a partial or complete remission following transplantation. Overall, 29 women (43%) were in complete remission after marrow transplantation. Twelve women (18% overall) remain free of disease between 2 and 73+ months post-ABMT. Those in first complete or partial remission prior to transplant (37 patients) had a higher response rate (86%) and higher complete responses (62%), and 10 (27%) are free of disease. There were nine treatment-related deaths (13%). Forty-seven patients (69%) have died from breast cancer following autologous transplantation. Relapses occurred primarily at sites of previous disease. All relapses have occurred within 22 months of ABMT.
Autologous bone marrow transplantation for metastatic breast cancer in first complete or partial remission has produced a 27% disease-free survival. This therapy should be considered for selected patients with metastatic breast cancer.
转移性乳腺癌占美国女性癌症死亡人数的18%。传统联合化疗可使50%至80%的转移性乳腺癌女性产生反应，但无法治愈。1983年至1993年间，一家大型医疗中心对68例转移性乳腺癌女性进行了高剂量化疗和自体骨髓移植。其中49名女性患有雌激素受体阴性肿瘤，这是一个不良预后指标。18名雌激素受体阳性肿瘤女性先前的激素治疗失败或在初次诊断时就患有转移性乳腺癌。移植前，37名女性处于首次完全或部分缓解期，8名处于第二次完全或部分缓解期，4名病情稳定，14名病情进展，5名处于未治疗的复发期。骨髓移植预处理方案包括高剂量单药或联合化疗。在移植前未缓解的女性中，71%在移植后进入部分或完全缓解期。总体而言，29名女性（43%）在骨髓移植后处于完全缓解期。12名女性（总体18%）在自体骨髓移植后2至73 +个月无疾病。移植前处于首次完全或部分缓解期的患者（37例）有较高的反应率（86%）和较高的完全缓解率（62%），10名（27%）无疾病。有9例治疗相关死亡（13%）。47名患者（69%）在自体移植后死于乳腺癌。复发主要发生在既往疾病部位。所有复发均发生在自体骨髓移植后22个月内。
首次完全或部分缓解的转移性乳腺癌患者进行自体骨髓移植可产生27%的无病生存率。对于选定的转移性乳腺癌患者应考虑这种治疗方法。
