Journal
BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION
Volume 10, Issue 6, Pages 415-425Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.bbmt.2004.02.004
Keywords
tumor contamination; apheresis products; high-dose chemotherapy; advanced breast cancer
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Funding
- NCI NIH HHS [R01 CA61532, R21 CA095762-01, R01 CA 615082] Funding Source: Medline
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We prospectively evaluated the prognostic significance of occult tumor cells (OTCs) contaminating the peripheral blood progenitor cell apheresis products of patients with advanced breast cancer receiving high-dose chemotherapy. Immunocytochemistry of peripheral blood progenitor cells was performed in 242 patients with high-risk primary breast cancer (HRPBC) and in 111 patients with metastatic breast cancer (MBC). OTCs were detected in 6.6% of HRPBC patients and in 16.2% of MBC patients (P=.005). In HRPBC, OTCs correlated with worse prognostic scores and larger tumor sizes, but not with axillary nodal status, hormone receptors, or HER2. In the MBC group, OTCs correlated with bone marrow involvement and with disease status at transplantation. The number of apheresis procedures was not associated with the risk of contamination. In HRPBC patients, at a median follow-up of 7 years (range, 1.5-11 years), the presence of OTCs correlated with worse event-free survival (P=.007) and overall survival (P=.002). In the MBC group, OTCs correlated with worse event-free survival (P=.04), but not overall survival (P=.2). In multivariate analyses, the presence of OTCs had an independent adverse effect on outcome in HRPBC, but not MBC. Our observations imply a direct role of OTCs in posttransplantation relapse in HRPBC. (C) 2004 American Society for Blood and Marrow Transplantation.
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