Wörmann B, Meden H, Riggert J, Humpe A, Wulf G, Koch B, Köhler M, Kuhn W, Hiddemann W
Department of Internal Medicine, Georg-August-Universität, Göttingen, Germany.
Anticancer Res. 1998 May-Jun;18(3C):2237-41.
Women with breast cancer and > 10 positive lymph nodes have an unfavorable prognosis. The optimal combination and intensity of adjuvant chemotherapy is uncertain. Between July 1994 and December 1996 we treated 19 patients with early intensive followed by high-dose chemotherapy and autologous peripheral blood stem cell transplantation.
Patients were initially diagnosed with breast cancer and multiple positive lymph nodes. Induction chemotherapy consisted of two courses VP16, ifosphamide, cisplatin and epirubicin (VIPE) and one course of mitoxantrone, cyclophosphamide and thiotepa (MCT). Peripheral blood stem cells were mobilized after the first or second course of VIPE and retransfused two days after high dose chemotherapy.
Stem cells were successfully collected in all patients. Major toxicities (WHO grade III and IV) were neutropenia, thrombocytopenia, alopecia, nausea, infections and mucositis. Hematopoietic recovery occurred in all patients with a median of 10 days for leukocytes and 13 days for platelets. No patient died of therapy-induced complications. The median observation time is 24 months. Two patients have relapsed, one with locoregional disease. The projected rate of patients with disease-free survival after three years is 88%.
Early intensive and myeloablative chemotherapy followed by peripheral blood stem cell transplantation is a highly efficient and feasible protocol for high risk patients with breast cancer.
患有乳腺癌且腋窝淋巴结转移≥10枚的女性预后较差。辅助化疗的最佳联合方案及强度尚不确定。1994年7月至1996年12月期间，我们对19例患者采用了早期强化化疗，随后进行大剂量化疗及自体外周血干细胞移植。
患者最初诊断为乳腺癌且有多个阳性腋窝淋巴结。诱导化疗包括两个疗程的依托泊苷、异环磷酰胺、顺铂和表柔比星（VIPE），以及一个疗程的米托蒽醌、环磷酰胺和塞替派（MCT）。外周血干细胞在第一个或第二个VIPE疗程后动员采集，并在大剂量化疗后两天回输。
所有患者均成功采集到干细胞。主要毒性反应（WHO Ⅲ/Ⅳ级）为中性粒细胞减少、血小板减少、脱发、恶心、感染和黏膜炎。所有患者均出现造血恢复，白细胞恢复的中位时间为10天，血小板恢复的中位时间为13天。无患者死于治疗相关并发症。中位观察时间为24个月。2例患者复发，1例为局部区域复发。预计三年无病生存率为88%。
对于高危乳腺癌患者，早期强化及清髓性化疗后进行外周血干细胞移植是一种高效且可行的方案。
