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Factors correlated with progression-free survival after high-dose chemotherapy and hematopoietic stem cell transplantation for metastatic breast cancer. JAMA 1999 Oct 13;282(14):1335-43 PMID: 10527180

Pubmed ID



CONTEXT: Women with breast cancer are the most frequent recipients of high-dose chemotherapy followed by autologous hematopoietic stem cell transplantation (autotransplants) in North America. Despite widespread use, controversy exists about the benefits of and appropriate patients for this therapy.

OBJECTIVE: To determine factors associated with disease progression or death after autotransplantation in women with metastatic breast cancer.

DESIGN: Analysis of data collected retrospectively (January 1989 to 1992) and prospectively (1992 through January 1995) for the Autologous Blood and Marrow Transplant Registry.

SETTING: Sixty-three hospitals in North America, Brazil, and Russia.

PARTICIPANTS: A total of 1188 consecutive women aged 18 to 70 years receiving autotransplants for metastatic or locally recurrent breast cancer, with a median follow-up of 291/2 months.

MAIN OUTCOME MEASURE: Time to treatment failure (disease progression, disease recurrence, or death) after autotransplantation.

RESULTS: Factors associated with significantly (P<.05) increased risk of treatment failure in a Cox multivariate analysis included age older than 45 years (relative hazard, 1.17; 95% confidence interval [CI], 1.02-1.33), Karnofsky performance score less than 90% (1.27; 95% CI, 1.07-1.51), absence of hormone receptors (1.31; 95% CI, 1.15-1.51), prior use of adjuvant chemotherapy (1.31; 95% CI, 1.10-1.56), initial disease-free survival interval after adjuvant treatment of no more than 18 months (1.99; 95% CI, 1.62-2.43), metastases in the liver (1.47; 95% CI, 1.20-1.80) or central nervous system (1.56; 95% CI, 0.99-2.46 [approaches significance]) vs soft tissue, bone, or lung, 3 or more sites of metastatic disease (1.32; 95% CI, 1.13-1.54), and incomplete response vs complete response to standard-dose chemotherapy (1.65; 95% CI, 1.36-1.99). Receiving tamoxifen posttransplantation was associated with a reduced risk of treatment failure in women with hormone receptor-positive tumors (relative hazard, 0.60; 95% CI, 0.47-0.87). Women with no risk factors (n = 38) had a 3-year probability of progression-free survival of 43% (95% CI, 27%-61 %) vs 4% (95% CI, 2%-8%) for women with more than 3 risk factors (n = 343).

CONCLUSION: These data indicate that some women are unlikely to benefit from autotransplantation and should receive this treatment only after being provided with prognostic information and in the context of clinical trials attempting to improve outcome.

Author List

Rowlings PA, Williams SF, Antman KH, Fields KK, Fay JW, Reed E, Pelz CJ, Klein JP, Sobocinski KA, Kennedy MJ, Freytes CO, McCarthy PL Jr, Herzig RH, Stadtmauer EA, Lazarus HM, Pecora AL, Bitran JD, Wolff SN, Gale RP, Armitage JO, Vaughan WP, Spitzer G, Horowitz MM


Mary M. Horowitz MD, MS Center Director, Professor in the Medicine department at Medical College of Wisconsin


2-s2.0-0033552263   62 Citations

MESH terms used to index this publication - Major topics in bold

Antineoplastic Agents, Hormonal
Antineoplastic Combined Chemotherapy Protocols
Bone Marrow Transplantation
Breast Neoplasms
Chemotherapy, Adjuvant
Disease Progression
Hematopoietic Stem Cell Transplantation
Middle Aged
Multivariate Analysis
Neoplasm Metastasis
Proportional Hazards Models
Receptors, Estrogen
Survival Analysis
Transplantation, Autologous
Treatment Failure
jenkins-FCD Prod-332 f92a19b0ec5e8e1eff783fac390ec127e367c2b5