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Annals of Oncology 2004 15(11):1627-1632; doi:10.1093/annonc/mdh433
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© 2004 European Society for Medical Oncology

Original Article

Micrometastatic bone marrow cells at diagnosis have no impact on survival of primary breast cancer patients with extensive axillary lymph node involvement treated with stem cell-supported high-dose chemotherapy

A. Schneeweiss1,*, I. Diel2, M. Hensel3, S. Kaul1, H.-P. Sinn4, K. Unnebrink5, C. Rudlowski1, I. Lauschner1, F. Schuetz1, G. Egerer3, R. Haas6, A. D. Ho3 and G. Bastert1

1 University of Heidelberg, Department of Gynecology and Obstetrics, Heidelberg; 2 Institute for Gynecological Oncology, Mannheim; 3 University of Heidelberg, Department of Internal Medicine V, Heidelberg; 4 University of Heidelberg, Department of Pathology, Heidelberg; 5 University of Heidelberg, Coordination Center for Clinical Trials, Heidelberg; 6 University of Düsseldorf, Department of Hematology and Oncology, Düsseldorf, Germany

* Correspondence to: Dr A. Schneeweiss, University of Heidelberg, Department of Gynecology and Obstetrics, Vossstrasse 9, D-69115 Heidelberg, Germany. Tel: +49-6221-567856; Fax: +49-6221-567920; Email: andreas_schneeweiss{at}med.uni-heidelberg.de

Backround: To determine the impact of micrometastatic bone marrow cells (MMC) on survival in high-risk primary breast cancer (HRPBC) patients treated with high-dose chemotherapy (HDCT) and autologous stem cell transplantation (ASCT).

Patients and methods: Ninety-one HRPBC patients (73 patients with ≥10 involved axillary lymph nodes (ALN), 18 premenopausal women with ≥4 involved ALN) received one cycle (eight patients) or two cycles of HDCT and ASCT. Bone marrow aspiration was performed before systemic treatment to search for MMC using a cocktail of four monoclonal epithelial-specific antibodies (5D3, HEA125, BM7 and BM8). The influence of MMC and other prognostic factors on disease-free survival (DFS), distant DFS (DDFS), and overall survival (OS) was analysed.

Results: In 23 of 91 patients (25%) we detected a median of three MMC (range, 1–43) among 106 mononuclear cells. With a median follow-up of 62 months (range, 10–117), the detection of MMC was not associated with DFS (P=0.929), DDFS (P=0.664) or OS (P=0.642). In multivariate analysis the strongest predictor was nodal ratio for DFS (P=0.012) and expression of p53 for OS (P <0.001).

Conclusion: The detection of MMC at diagnosis has no impact on survival in HRPBC patients treated with HDCT and ASCT.

Key words: high-dose chemotherapy, micrometastatic bone marrow cells, primary breast cancer, prognostic impact, survival


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