Prognostic Analysis of Early Lymphocyte Recovery in Patients with Advanced Breast Cancer Receiving High-Dose Chemotherapy with an Autologous Hematopoietic Progenitor Cell Transplant
Purpose: The purpose of this study was to evaluate the prognostic effect of early posttransplant lymphocyte recovery in patients with advanced breast cancer receiving high-dose chemotherapy with autologous hematopoietic progenitor cell transplantation. Experimental Design: We analyzed the effect of...
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| Published in: | Clinical cancer research Vol. 10; no. 15; pp. 5076 - 5086 |
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| Main Authors: | , , , , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
Philadelphia, PA
American Association for Cancer Research
01-08-2004
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| Subjects: | |
| Online Access: | Get full text |
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| Summary: | Purpose: The purpose of this study was to evaluate the prognostic effect of early posttransplant lymphocyte recovery in patients with
advanced breast cancer receiving high-dose chemotherapy with autologous hematopoietic progenitor cell transplantation.
Experimental Design: We analyzed the effect of the absolute lymphocyte count on day +15 posttransplant on freedom from relapse and overall survival
in patients with high-risk primary breast cancer or metastatic breast cancer, enrolled between 1990 and 2001 in prospective
high-dose chemotherapy trials, using a uniform regimen of cyclophosphamide, cisplatin, and 1,3-bis(2-chloroethyl)-1-nitrosourea.
Results: Four hundred and seventy-six patients (264 high-risk primary breast cancer and 212 metastatic breast cancer patients) were
evaluated at median follow-up of 8 years (range, 1.5–11 years). The disease-free survival and overall survival rates in the
high-risk primary breast cancer group were 67% and 70%, respectively. Patients with metastatic breast cancer patients had
21.8% disease-free survival and 31.5% overall survival rates. Day +15 absolute lymphocyte count correlated with freedom from
relapse ( P = 0.007) and overall survival ( P = 0.04) in the metastatic breast cancer group, but not in the high-risk primary breast cancer group ( P = 0.5 and 0.8, respectively). The prognostic effect of absolute lymphocyte count in metastatic breast cancer was restricted
to those patients receiving unmanipulated peripheral blood progenitor cells ( P = 0.04). In contrast, absolute lymphocyte count had no significant effect in those metastatic breast cancer patients receiving
bone marrow or a CD34-selected product. In multivariate analyses, the prognostic effect of day +15 absolute lymphocyte count
in metastatic breast cancer was independent of other predictors, such as disease status, pre-high-dose chemotherapy treatment,
number of tumor sites, or HER2.
Conclusions: Early lymphocyte recovery is an independent outcome predictor in metastatic breast cancer patients receiving high-dose chemotherapy
and an autologous peripheral blood progenitor cell transplant. These observations suggest that immune strategies targeting
minimal posttransplant residual disease may prove worthwhile. |
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| Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
| ISSN: | 1078-0432 1557-3265 |
| DOI: | 10.1158/1078-0432.CCR-04-0117 |