Autologous Bone Marrow Transplantation - Blog Science Connections

506 Panel Discussion: Session IV
a projected 40-50% disease-free survivorship in that group. You're going to
have a lot of work cut out for you to prove the superiority of higher dose
chemotherapy in that group.
DR. PETERS: Even if, in the 10-node adjuvant setting, the disease-free
survival rate ends up being optimistically 30%, there's still 70% of the women
who are being committed to dying of their disease. You will surely not make a
major impact in the metastatic disease setting very soon and the only time to do
it will be to do it early in the treatment settings. 1 think it's warranted.
DR. SPITZER: Except the problem is, Bill, that after we have the next set of
adjuvant studies in this group, then maybe we will identify a subgroup within that
group which has the 10-20% classic long-term, disease-free survivorship in
whom it is appropriate to do transplant studies. Like in the inflammatory disease
study, that subgroup is already identified as patients with residual disease after
initial induction chemotherapy at the time of surgery. This is the subgroup with
the bad outlook versus those who have a CR who have almost a 60-70% cure
rate. So we should wait a little longer to identify the study group better.
DR. ANTMAN: One comment on bone marrow metastases in light of Dr.
Spitzer's comment. There are three groups that I am aware of who are looking at
cleaning up the marrow with breast cancer. There's the group at Jerusalem, the
group in England at the Royal Marsden, and some groups in the United States.
However, I think the important issue is to be able to get CRs in the patients first,
in patients with known negative marrow, and then we can look at cleaning up the
marrow.
DR. SPITZER: Yes, I agree, Karen. If we have a high response rate, CR rates
of 70-80%, and still have continuing relapses, then I think we've found that
marrow contamination is a problem.