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Role of High-Dose Adjuvant Chemotherapy Followed by Autologous Stem Cell Transplantation in Locally Advanced Triple-Negative Breast Cancer: A Retrospective Chart Review. JOURNAL OF ONCOLOGY 2022; 2022:3472324. [PMID: 36213836 PMCID: PMC9546640 DOI: 10.1155/2022/3472324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 06/13/2022] [Accepted: 06/16/2022] [Indexed: 11/17/2022]
Abstract
Purpose. Women with locally advanced/high-risk triple-negative breast cancer treated with the current standard chemotherapy continue to have a poor prognosis. High-dose chemotherapy with autologous stem cell transplant as treatment for locally advanced/high-risk breast cancer remains controversial due to a lack of survival benefit seen in previous phase III trials. However, these trials evaluated a heterogeneous group of patients with different receptor subtypes. A marginal benefit was observed in certain subgroups. We report long-term outcomes of women with stage IIB or III triple-negative breast cancer treated with high-dose chemotherapy followed by autologous stem cell transplant at our institution between 1995 and 2001. Methods. This is a retrospective analysis of stage IIB or stage III triple-negative breast cancer treated with high-dose chemotherapy followed by autologous stem cell transplant. We excluded women with hormone-positive, HER2/neu-positive/unknown, and/or metastatic disease prior to transplant as per updated AJCC 7th edition guidelines. Patients underwent surgery and either neoadjuvant or adjuvant anthracycline and taxane-based chemotherapy and then proceeded to high-dose chemotherapy and autologous stem cell transplant using carmustine 600 mg/sqm, cyclophosphamide 5.6gm/sqm, and cisplatin 165 mg/sqm (STAMP 1 regimen) for consolidation. This was followed by locoregional breast and lymph node radiation per standard of care. Results. Twenty-nine women (2 stage IIB and 27 stage III) were evaluated. The median age at diagnosis was 43 years (IQR: 40, 51). Eleven patients had 4–9 regional lymph nodes (LN) involved and 16 had 10+ involved LNs. Four patients had T4 or inflammatory breast cancer and two had ipsilateral supraclavicular LNs involved. The median follow-up time is 16 years (95% CI: 12, 19, range <1–19 y) posttransplant. The median overall survival was 15 years (95% CI: 3, 19); the median DFS was 14 years (95% CI: 1, 19). Conclusions. This study of locally advanced/high-risk triple-negative breast cancer treated with adjuvant high-dose chemotherapy and autologous stem cell transplant reveals high overall survival rate. With the current improvement in treatment-related mortality, re-evaluating this approach in this subset of high-risk breast cancer in prospective randomized studies may be worthwhile.
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Martino M, Recchia AG, Console G, Gentile M, Cimminiello M, Gallo GA, Ferreri A, Naso V, Irrera G, Messina G, Moscato T, Vigna E, Vincelli ID, Morabito F. Can we improve the conditioning regimen before autologous stem cell transplantation in multiple myeloma? Expert Opin Orphan Drugs 2017. [DOI: 10.1080/21678707.2017.1387050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Massimo Martino
- Stem Cell Transplant Unit, Department of Onco-Hematology and Radiotherapy, Great Metropolitan Hospital BMM, Reggio Calabria, Italy
| | | | - Giuseppe Console
- Stem Cell Transplant Unit, Department of Onco-Hematology and Radiotherapy, Great Metropolitan Hospital BMM, Reggio Calabria, Italy
| | - Massimo Gentile
- Hematology Unit, Department of Hemato-Oncology, Ospedale Annunziata, Cosenza, Italy
| | - Michele Cimminiello
- Hematology and Stem Cell Transplantation Unit, “S. Carlo” Hospital, Potenza, Italy
| | - Giuseppe Alberto Gallo
- Stem Cell Transplant Unit, Department of Onco-Hematology and Radiotherapy, Great Metropolitan Hospital BMM, Reggio Calabria, Italy
| | - Anna Ferreri
- Stem Cell Transplant Unit, Department of Onco-Hematology and Radiotherapy, Great Metropolitan Hospital BMM, Reggio Calabria, Italy
| | - Virginia Naso
- Stem Cell Transplant Unit, Department of Onco-Hematology and Radiotherapy, Great Metropolitan Hospital BMM, Reggio Calabria, Italy
| | - Giuseppe Irrera
- Stem Cell Transplant Unit, Department of Onco-Hematology and Radiotherapy, Great Metropolitan Hospital BMM, Reggio Calabria, Italy
| | - Giuseppe Messina
- Stem Cell Transplant Unit, Department of Onco-Hematology and Radiotherapy, Great Metropolitan Hospital BMM, Reggio Calabria, Italy
| | - Tiziana Moscato
- Stem Cell Transplant Unit, Department of Onco-Hematology and Radiotherapy, Great Metropolitan Hospital BMM, Reggio Calabria, Italy
| | - Ernesto Vigna
- Hematology Unit, Department of Hemato-Oncology, Ospedale Annunziata, Cosenza, Italy
| | - Iolanda Donatella Vincelli
- Hematology, Department of Onco-Hematology and Radiotherapy, Great Metropolitan Hospital BMM, Reggio, Italy
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Boudin L, Gonçalves A, Sabatier R, Moretta J, Sfumato P, Asseeva P, Livon D, Bertucci F, Extra JM, Tarpin C, Houvenaeghel G, Lambaudie E, Tallet A, Resbeut M, Sobol H, Charafe-Jauffret E, Calmels B, Lemarie C, Boher JM, Viens P, Eisinger F, Chabannon C. Highly favorable outcome in BRCA-mutated metastatic breast cancer patients receiving high-dose chemotherapy and autologous hematopoietic stem cell transplantation. Bone Marrow Transplant 2016; 51:1082-6. [PMID: 27042835 DOI: 10.1038/bmt.2016.82] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 02/20/2016] [Accepted: 02/24/2016] [Indexed: 01/04/2023]
Abstract
Breast cancer carrying BRCA mutation may be highly sensitive to DNA-damaging agents. We hypothesized a better outcome for BRCA-mutated (BRCA(mut)) metastatic breast cancer (MBC) patients receiving high-dose chemotherapy and autologous hematopoietic stem cell transplantation (HDC AHSCT) versus unaffected BRCA (BRCA wild type; (BRCA(wt))) or patients without documented BRCA mutation (BRCA untested (BRCA(ut))). All female patients treated for MBC with AHSCT at Institut Paoli-Calmettes between 2003 and 2012 were included. BRCA(mut) and BRCA(wt) patients were identified from our institutional genetic database. Overall survival (OS) was the primary end point. A total of 235 patients were included. In all, 15 patients were BRCA(mut), 62 BRCA(wt) and 149 BRCA(ut). In multivariate analyses, the BRCA(mut) status was an independent prognostic factor for OS (hazard ratio (HR): 3.08, 95% confidence interval (CI): 1.10-8.64, P=0.0326) and PFS (HR: 2.52, 95% CI :1.29-4.91, P=0.0069). In this large series of MBC receiving HDC AHSCT, we report a highly favorable survival outcome in the subset of patients with documented germline BRCA mutations.
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Affiliation(s)
- L Boudin
- Département d'Oncologie Médicale, Institut Paoli-Calmettes (IPC), Marseille, France
| | - A Gonçalves
- Département d'Oncologie Médicale, Institut Paoli-Calmettes (IPC), Marseille, France.,Centre de Recherches en Cancérologie de Marseille (CRCM), Marseille, France.,Aix-Marseille Université, Marseille, France
| | - R Sabatier
- Département d'Oncologie Médicale, Institut Paoli-Calmettes (IPC), Marseille, France.,Centre de Recherches en Cancérologie de Marseille (CRCM), Marseille, France
| | - J Moretta
- Département d'Anticipation et de Suivi du Cancer, Institut Paoli-Calmettes, Marseille, France
| | - P Sfumato
- Biostatistiques, Département de la Recherche Clinique et de l'Innovation (DRCI), Institut Paoli-Calmettes, Marseille, France
| | - P Asseeva
- Département d'Anticipation et de Suivi du Cancer, Institut Paoli-Calmettes, Marseille, France
| | - D Livon
- Département d'Anticipation et de Suivi du Cancer, Institut Paoli-Calmettes, Marseille, France
| | - F Bertucci
- Département d'Oncologie Médicale, Institut Paoli-Calmettes (IPC), Marseille, France.,Centre de Recherches en Cancérologie de Marseille (CRCM), Marseille, France.,Aix-Marseille Université, Marseille, France
| | - J-M Extra
- Département d'Oncologie Médicale, Institut Paoli-Calmettes (IPC), Marseille, France
| | - C Tarpin
- Département d'Oncologie Médicale, Institut Paoli-Calmettes (IPC), Marseille, France
| | - G Houvenaeghel
- Centre de Recherches en Cancérologie de Marseille (CRCM), Marseille, France.,Aix-Marseille Université, Marseille, France.,Département de Chirurgie Oncologique, Institut Paoli-Calmettes, Marseille, France
| | - E Lambaudie
- Centre de Recherches en Cancérologie de Marseille (CRCM), Marseille, France.,Aix-Marseille Université, Marseille, France.,Département de Chirurgie Oncologique, Institut Paoli-Calmettes, Marseille, France
| | - A Tallet
- Département de Radiothérapie, Institut Paoli-Calmettes, Marseille, France
| | - M Resbeut
- Département de Radiothérapie, Institut Paoli-Calmettes, Marseille, France
| | - H Sobol
- Aix-Marseille Université, Marseille, France.,Département d'Anticipation et de Suivi du Cancer, Institut Paoli-Calmettes, Marseille, France
| | - E Charafe-Jauffret
- Centre de Recherches en Cancérologie de Marseille (CRCM), Marseille, France.,Aix-Marseille Université, Marseille, France.,Biopathologie, Département de Biologie du Cancer Institut Paoli-Calmettes, Marseille, France
| | - B Calmels
- Centre de Recherches en Cancérologie de Marseille (CRCM), Marseille, France.,Centre de Thérapie Cellulaire, Département de Biologie du Cancer, Institut Paoli-Calmettes, Marseille, France.,Centre d'Investigations Cliniques en Biothérapies, Marseille, France
| | - C Lemarie
- Centre de Thérapie Cellulaire, Département de Biologie du Cancer, Institut Paoli-Calmettes, Marseille, France.,Centre d'Investigations Cliniques en Biothérapies, Marseille, France
| | - J-M Boher
- Biostatistiques, Département de la Recherche Clinique et de l'Innovation (DRCI), Institut Paoli-Calmettes, Marseille, France
| | - P Viens
- Département d'Oncologie Médicale, Institut Paoli-Calmettes (IPC), Marseille, France.,Centre de Recherches en Cancérologie de Marseille (CRCM), Marseille, France.,Aix-Marseille Université, Marseille, France
| | - F Eisinger
- Centre de Recherches en Cancérologie de Marseille (CRCM), Marseille, France.,Aix-Marseille Université, Marseille, France.,Département d'Anticipation et de Suivi du Cancer, Institut Paoli-Calmettes, Marseille, France
| | - C Chabannon
- Centre de Recherches en Cancérologie de Marseille (CRCM), Marseille, France.,Aix-Marseille Université, Marseille, France.,Biopathologie, Département de Biologie du Cancer Institut Paoli-Calmettes, Marseille, France.,Centre de Thérapie Cellulaire, Département de Biologie du Cancer, Institut Paoli-Calmettes, Marseille, France
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Martino M, Lanza F, Pavesi L, Öztürk M, Blaise D, Leno Núñez R, Schouten HC, Bosi A, De Giorgi U, Generali D, Rosti G, Necchi A, Ravelli A, Bengala C, Badoglio M, Pedrazzoli P, Bregni M. High-Dose Chemotherapy and Autologous Hematopoietic Stem Cell Transplantation as Adjuvant Treatment in High-Risk Breast Cancer: Data from the European Group for Blood and Marrow Transplantation Registry. Biol Blood Marrow Transplant 2015; 22:475-81. [PMID: 26723932 DOI: 10.1016/j.bbmt.2015.12.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 12/17/2015] [Indexed: 11/19/2022]
Abstract
The aim of this retrospective study was to assess toxicity and efficacy of adjuvant high-dose chemotherapy (HDC) and autologous hematopoietic stem cell transplantation (AHSCT) in 583 high-risk breast cancer (BC) patients (>3 positive nodes) who were transplanted between 1995 and 2005 in Europe. All patients received surgery before transplant, and 55 patients (9.5%) received neoadjuvant treatment before surgery. Median age was 47.1 years, 57.3% of patients were premenopausal at treatment, 56.5% had endocrine-responsive tumors, 19.5% had a human epidermal growth factor receptor 2 (HER2)-negative tumor, and 72.4% had ≥10 positive lymph nodes at surgery. Seventy-nine percent received a single HDC procedure. Overall transplant-related mortality was 1.9%, at .9% between 2001 and 2005, whereas secondary tumor-related mortality was .9%. With a median follow-up of 120 months, overall survival and disease-free survival rates at 5 and 10 years in the whole population were 75% and 64% and 58% and 44%, respectively. Subgroup analysis demonstrated that rates of overall survival were significantly better in patients with endocrine-responsive tumors, <10 positive lymph nodes, and smaller tumor size. HER2 status did not affect survival probability. Adjuvant HDC with AHSCT has a low mortality rate and provides impressive long-term survival rates in patients with high-risk BC. Our results suggest that this treatment modality should be considered in selected high-risk BC patients and further investigated in clinical trials.
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Affiliation(s)
- Massimo Martino
- Hematology and Stem Cell Transplant Unit, Azienda Ospedaliera BMM, Reggio Calabria, Italy.
| | - Francesco Lanza
- Section of Hematology and Bone Marrow Transplant Unit, AO Isituti Ospitalieri di Cremona, Cremona, Italy
| | - Lorenzo Pavesi
- Department of Medical Oncology, Fondazione Salvatore Maugeri I.R.C.C.S., Pavia, Italy
| | - Mustafa Öztürk
- Gulhane Medical Academy, Department of Medical Oncology, General Tevfik Saglam Caddesi, Etlik/Ankara, Turkey
| | - Didier Blaise
- Department of Hematology, Institut Paoli Calmettes, Marseille, France
| | - Rubén Leno Núñez
- Department of Medical Oncology, Hospital Clínico Universitario, Salamanca, Spain
| | - Harry C Schouten
- Department of Hematology, Academische Ziekenhuis Maastricht, Maastricht, Netherlands
| | - Alberto Bosi
- Hematology Department, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Ugo De Giorgi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Italy
| | - Daniele Generali
- Breast Cancer Unit, AO Isituti Ospitalieri di Cremona, Cremona, Italy
| | - Giovanni Rosti
- Department of Medical Oncology, Civil Hospital, Ravenna, Italy
| | - Andrea Necchi
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andrea Ravelli
- Section of Hematology and Bone Marrow Transplant Unit, AO Isituti Ospitalieri di Cremona, Cremona, Italy
| | - Carmelo Bengala
- Department of Medical Oncology, Misericordia Hospital, Grosseto, Italy
| | - Manuela Badoglio
- European Group for Blood and Marrow Transplantation Study Office, Solid Tumors Working Party-EBMT, Hôpital Saint-Antoine, Assistance Publique des Hôpitaux de Paris, France
| | - Paolo Pedrazzoli
- Department of Medical Oncology, I.R.C.C.S. San Matteo University Hospital Foundation, Pavia, Italy
| | - Marco Bregni
- Department of Medical Oncology, di Circolo Hospital, Busto Arsizio, Italy
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5
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Musso M, Messina G, Marcacci G, Crescimanno A, Console G, Donnarumma D, Scalone R, Pinto A, Martino M. High-Dose Melphalan Plus Thiotepa as Conditioning Regimen before Second Autologous Stem Cell Transplantation for “De Novo” Multiple Myeloma Patients: A Phase II Study. Biol Blood Marrow Transplant 2015; 21:1932-8. [DOI: 10.1016/j.bbmt.2015.06.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 06/12/2015] [Indexed: 12/12/2022]
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6
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Pedrazzoli P, Martino M, Delfanti S, Generali D, Rosti G, Bregni M, Lanza F. High-Dose Chemotherapy With Autologous Hematopoietic Stem Cell Transplantation for High-Risk Primary Breast Cancer. J Natl Cancer Inst Monogr 2015; 2015:70-5. [DOI: 10.1093/jncimonographs/lgv010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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7
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Sureda A, Bader P, Cesaro S, Dreger P, Duarte RF, Dufour C, Falkenburg JHF, Farge-Bancel D, Gennery A, Kröger N, Lanza F, Marsh JC, Nagler A, Peters C, Velardi A, Mohty M, Madrigal A. Indications for allo- and auto-SCT for haematological diseases, solid tumours and immune disorders: current practice in Europe, 2015. Bone Marrow Transplant 2015; 50:1037-56. [PMID: 25798672 DOI: 10.1038/bmt.2015.6] [Citation(s) in RCA: 216] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 01/09/2015] [Indexed: 12/17/2022]
Abstract
This is the sixth special report that the European Society for Blood and Marrow Transplantation regularly publishes on the current practice and indications for haematopoietic SCT for haematological diseases, solid tumours and immune disorders in Europe. Major changes have occurred in the field of haematopoietic SCT over the last years. Cord blood units as well as haploidentical donors have been increasingly used as stem cell sources for allo-SCT, thus, augmenting the possibility of finding a suitable donor for a patient. Continuous refinement of conditioning strategies has also expanded not only the number of potential indications but also has permitted consideration of older patients or those with co-morbidity for a transplant. There is accumulating evidence of the role of haematopoietic SCT in non-haematological disorders such as autoimmune diseases. On the other hand, the advent of new drugs and very effective targeted therapy has challenged the role of SCT in some instances or at least, modified its position in the treatment armamentarium of a given patient. An updated report with revised tables and operating definitions is presented.
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Affiliation(s)
- A Sureda
- Department of Haematology, Institut Catala d'Oncologia, Hospital Duran I Reynals, Barcelona, Spain
| | - P Bader
- Universitätsklinikum Frankfurt, Goethe-Universität, Klinik für Kinder- und Jugendmedizin, Frankfurt, Germany
| | - S Cesaro
- Paediatric Haematology Oncology, Policlinico G.B. Rossi, Verona, Italy
| | - P Dreger
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - R F Duarte
- Department of Haematology, Institut Catala d'Oncologia, Hospital Duran I Reynals, Barcelona, Spain
| | - C Dufour
- Clinical And Experimental Hematology Unit. Institute G. Gaslini, Genoa, Italy
| | - J H F Falkenburg
- Department of Haematology, Leiden University Medical Center, Leiden, The Netherlands
| | - D Farge-Bancel
- Department of Haematology-BMT, Hopital St Louis, Paris, France
| | - A Gennery
- Children's BMT Unit, Great North Children's Hospital, Newcastle-Upon-Tyne, UK
| | - N Kröger
- Department of Stem Cell Transplantation, University hospital Eppendorf, Hamburg, Germany
| | - F Lanza
- Haematology and BMT Unit, Cremona, Italy
| | - J C Marsh
- Department of Haematological Medicine, King's College Hospital/King's College London, London, UK
| | - A Nagler
- Chaim Sheva Medical Center, Tel-Hashomer, Israel
| | - C Peters
- Stem Cell Transplantation Unit, St Anna Kinderspital, Vienna, Austria
| | - A Velardi
- Sezione di Ematologia, Dipartimento di Medicina Clinica e Sperimentale, Università di Perugia, Perugia, Italy
| | - M Mohty
- Department of Haematology, H. Saint Antoine, Paris, France
| | - A Madrigal
- Anthony Nolan Research Institute, Royal Free and University College, London, UK
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