Autologous Bone Marrow Transplantation - Blog Science Connections

High-Dose Chemotherapy Intensification and
Autologous Bone Marrow Transplantation
With Emphasis on Breast Carcinoma
Gary Spitzer, Aman Buzdar, Gabriel Hortobagyi,
Leonard Horwltz, Sundar Jagannath,
Kathleen Smith, and Karel Dicke
The treatment of stage IV breast carcinoma has been static since the
introduction of doxorubicin (Adriamycin) into combination chemotherapy
protocols about 10 years ago. Doxorubicin combined with alkylating agents,
antimetabolites, vinca alkaloids, steroids, or endocrine manipulation generates
an overall response rate of approximately 70% to 80% and a complete
remission (CR) rate of only about 20% to 30% (1-6). Unfortunately, few of these
CRs are durable (7). Breast cancer without the presence of estrogen receptors
appears to have a virulent, aggressive course; survival frequently is only for
about 12 months (4). Alternative strategies such as the use of alternating
non-cross-resistant combination chemotherapy regimens, new drugs, like
mitoxantrone, and biologies do not seem to have affected the rate and duration
of response of patients with hormonally unresponsive breast cancer (1 ).
Several recent analyses suggested that the response rate in stage IV breast
cancer patients and the freedom from relapse with use of adjuvant chemotherapy
for stage II disease are related to dose intensity, regardless of the
therapy program (8-12). High-dose chemotherapy studies in relapsing breast
455