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Home > Understanding Breast Cancer > Breast Cancer Research > Table 48: High-dose chemotherapy (bone marrow transplant)

  


Table 48: High-dose chemotherapy (bone marrow transplant)

This summary table contains detailed information about research studies. Summary tables offer an informative look at the science behind many breast cancer guidelines and recommendations. However, they should be viewed with some caution. In order to read and interpret research tables successfully, it is important to understand some key concepts. Learn how to read a research table.

Introduction: High-dose chemotherapy (sometimes called bone marrow transplant) was an experimental therapy that used high doses of drugs to try and kill a large number of cancer cells. Randomized clinical trials in the 1990s showed that high-dose chemotherapy was no more effective than standard dose chemotherapy and was fatal in about six percent of people [1-2]. It is no longer used to treat metastatic breast cancer and should only be considered in the context of a clinical trial. 

Study selection criteria: Randomized clinical trials with at least 200 participants and meta-analyses.

Table note: Although each study in this table compares high-dose chemotherapy with standard-dose chemotherapy, the exact drug combinations used vary from study to study.

Study 

Study Population
(number of participants)
 

Characteristics of Breast Cancer 

Follow-up
(years)
 

Results for
Metastatic Breast Cancer 

Results for
Non-metastatic Breast Cancer 

Randomized clinical trials 

Dutch Study Group [3]

885

4 or more positive nodes

5

 

Disease-free survival:
No overall difference. Some improvement in the high-dose group in women with 10 or more positive nodes.

Overall survival: No significant difference.

Treatment-related mortality: Low (1%) in high-dose group.

CALGB, SWOG, NCIC MA-13 [4]

785

10 or more positive nodes

7

 

Disease-free survival: No significant difference between the high-dose group and the intermediate-dose groups.

Survival: No significant difference in overall survival.

Recurrence: Among women younger than 50, fewer recurrences among those in the high-dose group vs. intermediate-dose group.

Treatment-related mortality: Higher among the high-dose group.

Leonard et al. [5]

605

4 or more positive nodes

6

 

Disease-free survival: No significant difference between the high-dose group and the low-dose group.

Overall survival: No significant difference.

Treatment-related mortality: No significant difference between the high-dose group and the low-dose group.

Scandinavian Breast Cancer Study Group [6]

525

Risk of recurrence within five years is 70% or greater

3

 

Disease-free survival: Significantly worse in high-dose group.

Treatment-related mortality: None.

Peters et al. [7]

425

Metastatic breast cancer

9

Survival: No difference between the high-dose group and the standard-dose group.

Treatment-related mortality: High (12%) in high-dose group.

 

West German Study Group [8]

403

9 or more positive nodes

4

 

Disease-free survival: Significantly improved with high-dose chemotherapy (60%) compared to standard therapy (44%).

Overall survival: Significantly improved with high-dose chemotherapy (75%) compared to standard therapy (70%).

International Breast Cancer Study Group Trial 15-95 [9]

344

10 or more positive nodes

 OR

4 or more positive nodes and ER- tumor

OR

4 or more positive nodes and tumor size > 5 cm

8

 

Disease-free survival: Significantly improved with high-dose chemotherapy (47%) compared to standard therapy (37%).

Overall survival: No significant difference.

Zander et al. [10]

307

10 or more positive nodes

4

 

Disease-free survival: No significant difference between the high-dose group and the low-dose group.

Overall survival: No significant difference.

Treatment-related mortality: Low (2%) in the high-dose group. Not measured well in the standard treatment arm, so unable to compare.

Note: Early results; study is on-going.

International Collaborative Cancer Group [11]

279

4 or more positive nodes

6

 

Disease-free survival: No significant difference in at 5 years between high-dose and standard dose groups.

Overall survival: No significant difference at 5 years.

Treatment-related mortality: Similar number of deaths related to treatment in both groups.

Pooled analyses 

Farquhar et al. [12]

5,064

4 or more positive nodes

   

Disease-free survival: High-dose group showed benefit at 3 and 4 years. No significant difference found at 5 and 6 years.

Overall survival: No significant difference.

Treatment-related mortality: Significantly higher in the high-dose group.

Note: Many studies in this analysis are ongoing.

Farquhar et al. [13]

850

Metastatic breast cancer

 

Disease-free survival: Significant increase in the high-dose group at 1 and 5 years.

Overall survival: No significant difference at 1, 3 or 5 years.

Treatment-related mortality: Significantly higher in the high-dose group.

 

 

References 

  1. Stadtmauer EA, O'Neill A, Goldstein LJ, et al. Conventional-dose chemotherapy compared with high-dose chemotherapy plus autologous hematopoietic stem-cell transplantation for metastatic breast cancer. Philadelphia Bone Marrow Transplant Group. N Engl J Med. 342: 1069-76, 2000.
  2. Crump M, Gluck S, Tu D, et al. Randomized trial of high-dose chemotherapy with autologous peripheral-blood stem-cell support compared with standard-dose chemotherapy in women with metastatic breast cancer: NCIC MA.16. J Clin Oncol. 26(1):37-43, 2008.
  3. Rodenhuis S, Bontenbal M, Beex LVAM, et al. High-dose chemotherapy with hematapoietic stem-cell rescue for high-risk breast cancer. N Engl J Med. 349:7-16, 2003.
  4. Peters WP, Rosner G, Vredenburgh J, et al. Prospective, randomized comparison of high-dose chemotherapy with stem-cell support versus intermediate-dose chemotherapy after surgery and adjuvant chemotherapy in women with high-risk primary breast cancer: a report of CALGB 9082, SWOG 9114, and NCIC MA-13. J Clin Oncol. 23(10):2191-200, 2005.
  5. Leonard RCF, Lind M, Twelves C, et al. Conventional adjuvant chemotherapy versus single-cycle, autograft-supported, high-dose, late-intensification chemotherapy in high-risk breast cancer patients: a randomized trial. J Natl Cancer Inst. 96(14):1076-83, 2004.
  6. The Scandinavian Breast Cancer Study Group 9401: Results from a randomized adjuvant breast cancer study with high dose chemotherapy with CTCb supported by autologous bone marrow stem cells versus escalated and tailored FEC therapy. Proc Am Soc Clin Oncol. 18:2a(Abstract 3), 1999.
  7. Peters WP, Jones RB, Vredenburgh J, et al. A large, prospective, randomized trial of high-dose combination alkylating agent (CPB) with autologous cellular support (ABMS) as consolidation for patients with metastatic breast cancer achieving complete remission after intensive doxorubicin-based induction therapy (AFM). Proc Am Soc Clin Oncol. 15:149a, 1996.
  8. Nitz UA, Mohrmann S, Fischer J, et al. for the West German Study Group. Comparison of rapidly cycled tandem high-dose chemotherapy plus peripheral-blood stem-cell support versus dose-dense conventional chemotherapy for adjuvant treatment of high-risk breast cancer: results of a multicentre phase III trial. Lancet. 366(9501):1935-44, 2005.
  9. Colleoni M, Sun Z, Martinelli G, et al. for the International Breast Cancer Study Group. The effect of endocrine responsiveness on high-risk breast cancer treated with dose-intensive chemotherapy: results of International Breast Cancer Study Group Trial 15-95 after prolonged follow-up. Ann Oncol. 20(8):1344-51, 2009.
  10. Zander AR, Kroger N, Schmoor C, et al. High-dose chemotherapy with autologous hematopoietic stem-cell support compared with standard-dose chemotherapy in breast cancer patients with 10 or more positive lymph nodes: First results of a randomized trial. J Clin Oncol. 22(12):2273-83, 2004.
  11. Coombes RC, Howell A, Emson A on behalf of the International Collaborative Cancer Group (ICCG). High dose chemotherapy and autologous stem cell transplantation as adjuvant therapy for primary breast cancer patients with four or more lymph nodes involved: long-term results of an international randomised trial. Ann Oncol. 16(5):726-34, 2005.
  12. Farquhar C, Marjoribanks J, Basser R, Lethaby A. High dose chemotherapy and autologous bone marrow or stem cell transplantation versus conventional chemotherapy for women with early poor prognosis breast cancer. Cochrane Database Syst Rev. 3:CD003139, 2005.
  13.  Farquhar C, Marjoribanks J, Basser R et al. High dose chemotherapy and autologous bone marrow or stem cell transplantation versus conventional chemotherapy for women with metastatic breast cancer (Review). The Cochrane Database Syst Rev. 3:CD003142.pub2, 2005.

Updated 02/05/14