Annals of Oncology 14:554-558, 2003
© 2003 European Society for Medical Oncology
Original Paper |
Low incidence of secondary myelodysplasia and acute myeloid leukemia after high-dose chemotherapy as adjuvant therapy for breast cancer patients: a study by the Solid Tumors Working Party of the European Group for Blood and Marrow Transplantation
1 Department of Bone Marrow Transplantation, University Hospital Hamburg, Hamburg, Germany; 2 Instituto Europeo di Oncologia, Milan, Italy; 3 Department of Oncology and Hematology, Ospedale Civile, Ravenna, Italy; 4 Bone Marrow Transplantation, Hospital General Universitario, Murcia, Spain; 5 Department of Oncology, Fondazione S. Maugeri, Pavia, Italy; 6 Department of Hematology, Oncology University of Ankara, Ankara, Turkey; 7 Bone Marrow Transplantation, Hospital St Louis, Paris, France
Received 8 August 2002; revised 11 October 2002; accepted 20 November 2002
Background:
To determine the incidence of secondary myelodysplasia (sMDS) or acute myeloid leukemia (AML) in node-positive breast cancer patients who received high-dose chemotherapy (HDCT) followed by autologous stem-cell support as adjuvant therapy.
Patients and methods:
The incidence of sMDS/AML was retrospectively assessed in 364 node-positive breast cancer patients who received HDCT followed by autologous stem-cell support as adjuvant therapy between November 1989 and December 1997 and were reported to the European Group for Blood and Marrow Transplantation registry.
Results:
The median age of the patients was 45 years (range 22–62 years). Two hundred and ninety-one patients received peripheral blood stem cells and 55 patients received autologous bone marrow as stem-cell support. The most frequently used conditioning regimen was the STAMP-V regimen (32%), followed by melphalan–thiotepa (22%) and melphalan–mitoxantrone–cyclophosphamide (21%). The 5-year probability of overall survival is 71% (95% CI 65% to 77%). After a median follow-up of 48 months (range 1–108 months) only one case of AML was observed, resulting in a crude incidence of 0.27%. This case of AML was observed 18 months after HDCT consisting of three cycles of epirubicin and cyclophosphamide with a cumulative dose of epirubicin 960 mg and cyclophosphamide 19 g. The French–American–British type of AML was M4, and the cytogenetic analysis showed a translocation t(9;11)(p22;q23). After complete remission following high-dose cytarabine and idarubicin the patient relapsed and died.
Conclusions:
In contrast to patients with malignant lymphoma there seems to be no increased risk of sMDS/AML after HDCT in breast cancer. Continued monitoring is required to confirm this low incidence after a longer follow-up period.
Key words: acute myeloid leukemia, adjuvant therapy, breast cancer, high-dose chemotherapy, secondary myelodysplasia