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Long-term survival in a fraction of patients with metastatic breast cancer who received consolidation therapy with high-dose chemotherapy and autologous stem cell transplant between 2000 and 2015: an EBMT registry-based study

Bone Marrow Transplantation volume 57, pages 276–278 (2022)Cite this article

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Breast cancer (BC) is the most common cancer and the leading cause of cancer mortality in women [1]. Despite advances in screening and treatment, nearly 12% of patients develop metastatic (M) disease. In the 80s and 90s, results of the early non-randomized clinical trials with high-dose chemotherapy (HDC) and autologous stem cell transplantation (ASCT) [2] demonstrated unusual improvements in patients with high-risk and MBC, creating great expectations with thousands of patients being treated with this modality, unfortunately in most cases given outside controlled trials [3]. In 2011, Berry et al. published the results of a meta-analysis, involving 866 women with MBC that evaluated HDC versus conventional chemotherapy (CC) [4]. The meta-analysis showed a statistically significant advantage for HDC in terms of PFS. However, this advantage did not translate into a survival benefit. Subsets of patients who may benefit from HDC were not identified due to the lack of information on biological parameters and the heterogeneity of HDC and CC regimens used. The meta-analysis did not include two prospective studies showing a potential survival benefit of HDC [5, 6].

This retrospective study analyzed the EBMT registry data regarding adult patients with MBC who underwent HDC and ASCT between 2000 and 2015. In the absence of robust prospective trials, the EBMT registry remains an important source to survey indications, outcomes, and clinical risk factors. OS and PFS were defined as time to death from any cause from the date of the first ASCT, and as the time from first transplantation to progression or death, respectively. OS and PFS were calculated through Kaplan–Meier (KM) analysis. A comparative analysis was conducted to select covariates associated with PFS by log-rank test. In Cox models, data were expressed as hazard ratio (HR), 95% CI, and p values.

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Fig. 1: PFS and OS of the study population.

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Author information

Author notes

  1. Alberto Zambelli

    Present address: Ospedale Papa Giovanni XXIII, Bergamo, Italy

Authors and Affiliations

  1. Stem Cell Transplant and Cellular Therapies, Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy

    Massimo Martino, Filippo Antonio Canale & Giuseppe Console

  2. Institute of Clinical Physiology (IFC), Rome, Italy

    Annalisa Pitino & Mercedes Gori

  3. Institut Paoli-Calmettes Department of Medical Oncology, Aix-Marseille Université, Inserm U1068, CNRS UMR7258, 13009, Marseille, France

    Patrice Viens

  4. Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milano, Italy and Dipartimento di Oncologia ed Emato-Oncologia, Università degli Studi di Milano (La Statale), Milano, Italy

    Salvatore Siena

  5. Institute of Clinical Physiology (IFC-CNR), Research Unit of Reggio Calabria, Reggio Calabria, Italy

    Giovanni Tripepi

  6. Department of Internal Medicine, Università di Genova, IRCCS Ospedale Policlinico San Martino, Genova, Italy

    Alberto Ballestrero

  7. Medical Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy

    Claudio Zamagni

  8. Hematology and Transplant Unit, Oncology Department La Maddalena, Palermo, Italy

    Maurizio Musso

  9. Istituti Clinici scientifici Maugeri, Pavia, Italy

    Alberto Zambelli

  10. Department Medicine V, University of Heidelberg, Heidelberg, Germany

    Peter Dreger

  11. EBMT Paris Study Office; Department of Haematology, Saint Antoine Hospital; INSERM UMR 938, Sorbonne University, Paris, France

    Manuela Badoglio

  12. Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy

    Simona Secondino & Paolo Pedrazzoli

  13. Institut Paoli-Calmettes, Centre de Thérapie Cellulaire, Aix-Marseille Université, INSERM CBT 1409, Centre for Clinical Investigation in Biotherapy, Marseille, France

    Christian Chabannon

  14. Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy

    Paolo Pedrazzoli

Authors
  1. Massimo Martino
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  2. Annalisa Pitino
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  3. Mercedes Gori
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  15. Giuseppe Console
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  16. Christian Chabannon
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  17. Paolo Pedrazzoli
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Consortia

on behalf of the EBMT Cellular Therapy and Immunobiology Working Party (CTIWP)

Contributions

MaMa, MB, CC, PP designed the study. MaMa, AP, MG, FAC, MB, GT, and PP wrote the manuscript. AP, MG, MB, and GT performed the statistical analysis. MaMa, PV, SS, AB, CZ, MaMu, AZ, DP, SS, GC, CC, PP provided cases for the study. All the authors edited and approved the final version of the manuscript.

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Correspondence to Massimo Martino.

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Martino, M., Pitino, A., Gori, M. et al. Long-term survival in a fraction of patients with metastatic breast cancer who received consolidation therapy with high-dose chemotherapy and autologous stem cell transplant between 2000 and 2015: an EBMT registry-based study. Bone Marrow Transplant 57, 276–278 (2022). https://doi.org/10.1038/s41409-021-01503-7

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