High-dose chemotherapy and autologous hematopoietic stem cell transplantation as adjuvant treatment in early stage and operable breast cancer: retrospective long-term analysis of the European experience

High-dose chemotherapy (HDC) with autologous stem cell transplantation (ASCT) as adjuvant treatment in high-risk early breast cancer can increase disease-free survival but it failed to improve overall survival in randomized phase III studies. We have performed a retrospective analysis of data available on EBMT registry to analyze the long term outcome of patients (pts) with early stage and operable breast cancer who underwent an adjuvant HDC with ASCT between 1995 and 2005. Objective of the study was to analyse the outcome of the pts according to prognostic factors including age, histological grade, hormonal receptor (HR) and HER-2 expression, menopausal status, number of axillary positive LNs, courses of chemotherapy before HDC, HDC procedure (single vs. multiple courses). So far data of 384 pts were collected from the EBMT registry, and additional data were required to the investigators. Histological grade was available in 300 pts, HR status in 382 pts, HER-2 status in 94 pts. Median age was 47 yrs (23-67); 60% of the pts had endocrine sensitive disease and 60% had an high grade disease; 13% of the pts had received neoadjuvant chemotherapy, and 67% were in premenopausal status. Median number of positive axillary LNs was 12 (3-46). All the pts received standard chemotherapy before HDC: (< 4 courses 81.3 %). A single course of HDC was performed in 84.4% of the pts. At a median follow-up of 120 months (5-182), the DFS and OS at 5 and 10 yrs are 62% and 43%, and 74% and 60% respectively. Transplant-related mortality was 3.3%. OS for pts with grade 1-2 vs. grade 3 disease was 86% vs. 68% and 67% vs. 58% at 5 yrs and 10 yrs, respectively (p: 0.025). DFS for pts with <10 or >10 positive axillary LNs at 5 and 10 yrs was 76% vs. 57% and 55% vs. 39% (p: 0.002). No statistical difference in DFS and OS was observed according to: age, HR status, HDC procedure, courses of chemotherapy before HDC. In conclusion, HDC is a safe procedure as a part of a multidisciplinary approach for pts with high-risk primary breast cancer. Optimal role of the this procedure in appropriate and biologically characterized subgroups of pts remains to be evaluated.
Disclosure: All authors have declared no conflicts of interest.