1. Sequential High-Dose Alkylating Therapy and Stem Cell Support for High-Risk Stage III Breast Cancer
- Author
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Carol Staugaard-Hahn, Elizabeth D'Andrea, Bruce G. Haffty, Barbara Burtness, Michal G. Rose, Josette Bou-Khalil, Edward A. Snyder, Dennis L. Cooper, John Pezzimente, Michael Reiss, Susan Gran, Erin Medoff, Christine Holtkamp, and Amanda Psyrri
- Subjects
Adult ,Oncology ,Melphalan ,medicine.medical_specialty ,Paclitaxel ,Axillary lymph nodes ,Cyclophosphamide ,medicine.medical_treatment ,Breast Neoplasms ,ThioTEPA ,Inflammatory breast cancer ,Medical Records ,Breast cancer ,Internal medicine ,Antineoplastic Combined Chemotherapy Protocols ,Granulocyte Colony-Stimulating Factor ,Internal Medicine ,Humans ,Medicine ,Neoplasm Staging ,Retrospective Studies ,Chemotherapy ,business.industry ,Palliative Care ,Middle Aged ,medicine.disease ,Survival Analysis ,Connecticut ,Treatment Outcome ,medicine.anatomical_structure ,Female ,Surgery ,Neoplasm Recurrence, Local ,business ,Mastectomy ,Stem Cell Transplantation ,medicine.drug - Abstract
Patients who receive neoadjuvant chemotherapy for locally advanced breast cancer and have four or more ipsilateral axillary lymph nodes involved at surgery are at high risk for recurrence, with a median time to relapse of 18 months. We offered such patients high-dose chemotherapy with stem cell rescue. Patients received cyclophosphamide or paclitaxel and granulocyte colony-stimulating factor (G-CSF) to mobilize stem cells. Melphalan 140 mg/m2 was then given with stem cell rescue. Twenty-four to 35 days later, thiotepa 900 mg/m2 was given with stem cell rescue. Patients with hormone receptor-positive tumors received tamoxifen. We treated 14 patients in this fashion from 1995 to 1998. The mean age was 46.7 years. The majority of cancers were stage IIIB (79%). Thirteen women underwent mastectomy after anthracycline-containing chemotherapy and 50% had more than seven positive lymph nodes. Hospitalization was principally for neutropenic fever. Other morbidities were pneumonitis, cardiomyopathy, and grade 3/4 white blood cell (WBC) toxicity. No patient died of a treatment-related complication. Seven of 14 relapsed at 10, 12
- Published
- 2003
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