Ljungman P, Björkstrand B, Fornander T, Höglund M, Juliusson G, Lindman H, Malmström A, Rotstein S, Söderberg M, Wilking N, Villman K, Bergh J
Dept. of Hematology, Huddinge University Hospital, Karolinska Institutet, Sweden.
Bone Marrow Transplant. 1998 Sep;22(5):445-8. doi: 10.1038/sj.bmt.1701367.
Ninety-four patients underwent high-dose chemotherapy with stem cell support for stage IV breast cancer. The high-dose chemotherapy consisted of the Stamp V regimen in all patients comprising cyclophosphamide, thiotepa and carboplatin (CTCb). Twenty-three patients received sequential high-dose therapies with the first consisting of high-dose melphalan and the second of Stamp V. Two patients died from chemotherapy-related complications resulting in a transplant-related mortality at 100 days of 2.2%. The progression-free survival at 3 years was 36% in patients with no evidence of disease at the first course of high-dose therapy compared with 17% in patients with remaining disease at time of the high-dose therapy (P = 0.03). There was no difference in overall survival between patients with no evidence of disease and other patients. The source of stem cells, single or double courses of high-dose therapy, positive selection of CD34+ cells, or number of involved sites had no influence on either progression-free survival or overall survival. Further studies of more intensive induction chemotherapy followed by high-dose therapy with stem cell support are indicated.
94例IV期乳腺癌患者接受了高剂量化疗及干细胞支持治疗。所有患者的高剂量化疗均采用Stamp V方案，包括环磷酰胺、噻替派和卡铂（CTCb）。23例患者接受了序贯高剂量治疗，第一次为大剂量美法仑，第二次为Stamp V方案。2例患者死于化疗相关并发症，导致100天移植相关死亡率为2.2%。在高剂量治疗的第一个疗程无疾病证据的患者中，3年无进展生存率为36%，而在高剂量治疗时仍有疾病的患者中为17%（P = 0.03）。无疾病证据的患者与其他患者的总生存率无差异。干细胞来源、单疗程或双疗程高剂量治疗、CD34+细胞的阳性选择或受累部位数量对无进展生存率或总生存率均无影响。需要进一步研究更强化的诱导化疗后联合干细胞支持的高剂量治疗。
