Conventional adjuvant chemotherapy with or without high-dose chemotherapy and autologous stem-cell transplantation in high-risk breast cancer

Martin S. Tallman, Robert Gray, Nicholas J. Robert, Charles F. LeMaistre, C. Kent Osborne, William P. Vaughan, William J. Gradishar, Thomas M. Pisansky, John Fetting, Elisabeth M. Paietta, Hillard M. Lazarus

Research output: Contribution to journalArticle

156 Citations (Scopus)

Abstract

BACKGROUND: The prognosis for women with primary breast cancer and 10 or more involved axillary lymph nodes is poor. High-dose chemotherapy with autologous hematopoietic stemcell transplantation has been reported to be effective in the adjuvant setting for patients at high risk for relapse. METHODS: We randomly assigned 540 female patients with primary breast cancer and at least 10 involved ipsilateral axillary lymph nodes to receive either six cycles of adjuvant chemotherapy with cyclophosphamide, doxorubicin, and fluorouracil (CAF) or the same adjuvant chemotherapy followed by high-dose chemotherapy with cyclophosphamide and thiotepa and autologous hematopoietic stem-cell transplantation. RESULTS: Among the 511 eligible patients, there was no significant difference in disease-free survival, overall survival, or the time to recurrence between those who received CAF alone and those who received CAF plus high-dose chemotherapy and stem-cell transplantation. Among 417 patients fulfilling strict eligibility criteria, the time to recurrence was longer for patients who underwent stem-cell transplantation than for those who received CAF alone. In the transplantation group, nine patients died of transplantation-related complications and a myelodysplastic syndrome or acute myeloid leukemia de eloped in nine. CONCLUSIONS: The addition of high-dose chemotherapy and autologous hematopoietic stem-cell transplantation to six cycles of adjuvant chemotherapy with CAF may reduce the risk of relapse but does not improve the outcome among patients with primary breast cancer and at least 10 involved axillary lymph nodes. Conventional-dose adjuvant chemotherapy remains the standard of care for such patients.

Original languageEnglish (US)
Pages (from-to)17-26
Number of pages10
JournalNew England Journal of Medicine
Volume349
Issue number1
DOIs
StatePublished - Jul 3 2003
Externally publishedYes

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Stem Cell Transplantation
Adjuvant Chemotherapy
Cyclophosphamide
Breast Neoplasms
Drug Therapy
Fluorouracil
Doxorubicin
Recurrence
Transplantation
Lymph Nodes
Hematopoietic Stem Cell Transplantation
Thiotepa
Myelodysplastic Syndromes
Standard of Care
Acute Myeloid Leukemia
Disease-Free Survival
Survival

ASJC Scopus subject areas

  • Medicine(all)

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Conventional adjuvant chemotherapy with or without high-dose chemotherapy and autologous stem-cell transplantation in high-risk breast cancer. / Tallman, Martin S.; Gray, Robert; Robert, Nicholas J.; LeMaistre, Charles F.; Osborne, C. Kent; Vaughan, William P.; Gradishar, William J.; Pisansky, Thomas M.; Fetting, John; Paietta, Elisabeth M.; Lazarus, Hillard M.

In: New England Journal of Medicine, Vol. 349, No. 1, 03.07.2003, p. 17-26.

Research output: Contribution to journalArticle

Tallman, MS, Gray, R, Robert, NJ, LeMaistre, CF, Osborne, CK, Vaughan, WP, Gradishar, WJ, Pisansky, TM, Fetting, J, Paietta, EM & Lazarus, HM 2003, 'Conventional adjuvant chemotherapy with or without high-dose chemotherapy and autologous stem-cell transplantation in high-risk breast cancer', New England Journal of Medicine, vol. 349, no. 1, pp. 17-26. https://doi.org/10.1056/NEJMoa030684
Tallman, Martin S. ; Gray, Robert ; Robert, Nicholas J. ; LeMaistre, Charles F. ; Osborne, C. Kent ; Vaughan, William P. ; Gradishar, William J. ; Pisansky, Thomas M. ; Fetting, John ; Paietta, Elisabeth M. ; Lazarus, Hillard M. / Conventional adjuvant chemotherapy with or without high-dose chemotherapy and autologous stem-cell transplantation in high-risk breast cancer. In: New England Journal of Medicine. 2003 ; Vol. 349, No. 1. pp. 17-26.
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AU - Gray, Robert

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AU - LeMaistre, Charles F.

AU - Osborne, C. Kent

AU - Vaughan, William P.

AU - Gradishar, William J.

AU - Pisansky, Thomas M.

AU - Fetting, John

AU - Paietta, Elisabeth M.

AU - Lazarus, Hillard M.

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N2 - BACKGROUND: The prognosis for women with primary breast cancer and 10 or more involved axillary lymph nodes is poor. High-dose chemotherapy with autologous hematopoietic stemcell transplantation has been reported to be effective in the adjuvant setting for patients at high risk for relapse. METHODS: We randomly assigned 540 female patients with primary breast cancer and at least 10 involved ipsilateral axillary lymph nodes to receive either six cycles of adjuvant chemotherapy with cyclophosphamide, doxorubicin, and fluorouracil (CAF) or the same adjuvant chemotherapy followed by high-dose chemotherapy with cyclophosphamide and thiotepa and autologous hematopoietic stem-cell transplantation. RESULTS: Among the 511 eligible patients, there was no significant difference in disease-free survival, overall survival, or the time to recurrence between those who received CAF alone and those who received CAF plus high-dose chemotherapy and stem-cell transplantation. Among 417 patients fulfilling strict eligibility criteria, the time to recurrence was longer for patients who underwent stem-cell transplantation than for those who received CAF alone. In the transplantation group, nine patients died of transplantation-related complications and a myelodysplastic syndrome or acute myeloid leukemia de eloped in nine. CONCLUSIONS: The addition of high-dose chemotherapy and autologous hematopoietic stem-cell transplantation to six cycles of adjuvant chemotherapy with CAF may reduce the risk of relapse but does not improve the outcome among patients with primary breast cancer and at least 10 involved axillary lymph nodes. Conventional-dose adjuvant chemotherapy remains the standard of care for such patients.

AB - BACKGROUND: The prognosis for women with primary breast cancer and 10 or more involved axillary lymph nodes is poor. High-dose chemotherapy with autologous hematopoietic stemcell transplantation has been reported to be effective in the adjuvant setting for patients at high risk for relapse. METHODS: We randomly assigned 540 female patients with primary breast cancer and at least 10 involved ipsilateral axillary lymph nodes to receive either six cycles of adjuvant chemotherapy with cyclophosphamide, doxorubicin, and fluorouracil (CAF) or the same adjuvant chemotherapy followed by high-dose chemotherapy with cyclophosphamide and thiotepa and autologous hematopoietic stem-cell transplantation. RESULTS: Among the 511 eligible patients, there was no significant difference in disease-free survival, overall survival, or the time to recurrence between those who received CAF alone and those who received CAF plus high-dose chemotherapy and stem-cell transplantation. Among 417 patients fulfilling strict eligibility criteria, the time to recurrence was longer for patients who underwent stem-cell transplantation than for those who received CAF alone. In the transplantation group, nine patients died of transplantation-related complications and a myelodysplastic syndrome or acute myeloid leukemia de eloped in nine. CONCLUSIONS: The addition of high-dose chemotherapy and autologous hematopoietic stem-cell transplantation to six cycles of adjuvant chemotherapy with CAF may reduce the risk of relapse but does not improve the outcome among patients with primary breast cancer and at least 10 involved axillary lymph nodes. Conventional-dose adjuvant chemotherapy remains the standard of care for such patients.

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