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Titolo:
Factors correlated with progression-free survival after high-dose chemotherapy and hematopoietic stem cell transplantation for metastatic breast cancer
Autore:
Rowlings, PA; Williams, SF; Antman, KH; Fields, KK; Fay, JW; Reed, E; Pelz, CJ; Klein, JP; Sobocinski, KA; Kennedy, MJ; Freytes, CO; McCarthy, PL; Herzig, RH; Stadtmauer, EA; Lazarus, HM; Pecora, AL; Bitran, JD; Wolff, SN; Gale, RP; Armitage, JO; Vaughan, WP; Spitzer, G; Horowitz, MM;
Indirizzi:
Med Coll Wisconsin, Hlth Policy Inst, Breast Canc Working Comm Autologous Blood & Marro, Milwaukee, WI 53226 USA Med Coll Wisconsin Milwaukee WI USA53226 Marro, Milwaukee, WI 53226 USA Univ Chicago, Med Ctr, Hematol Oncol Sect, Chicago, IL 60637 USA Univ Chicago Chicago IL USA 60637 matol Oncol Sect, Chicago, IL 60637 USA Columbia Univ, Div Med Oncol, New York, NY USA Columbia Univ New York NY USA mbia Univ, Div Med Oncol, New York, NY USA Univ S Florida, H Lee Moffitt Canc Ctr, Div Bone Marrow Transplantat, Tampa, FL 33682 USA Univ S Florida Tampa FL USA 33682 arrow Transplantat, Tampa, FL 33682 USA Baylor Univ, Sammons Canc Ctr, Dallas, TX USA Baylor Univ Dallas TX USABaylor Univ, Sammons Canc Ctr, Dallas, TX USA Univ Nebraska, Med Ctr, Div Hematol Oncol, Omaha, NE USA Univ Nebraska Omaha NE USA ka, Med Ctr, Div Hematol Oncol, Omaha, NE USA Johns Hopkins Hosp, Ctr Oncol, Baltimore, MD 21287 USA Johns Hopkins HospBaltimore MD USA 21287 Oncol, Baltimore, MD 21287 USA Univ Texas, Hlth Sci Ctr, Adult Bone Marrow Transplant Program, San Antonio, TX USA Univ Texas San Antonio TX USA ow Transplant Program, San Antonio, TX USA Roswell Pk Canc Inst, Dept Med, Buffalo, NY 14263 USA Roswell Pk Canc Inst Buffalo NY USA 14263 Dept Med, Buffalo, NY 14263 USA Univ Louisville, James Graham Brown Canc Ctr, Louisville, KY 40292 USA Univ Louisville Louisville KY USA 40292 anc Ctr, Louisville, KY 40292 USA Univ Penn, Bone Marrow Transplant Program, Philadelphia, PA 19104 USA UnivPenn Philadelphia PA USA 19104 t Program, Philadelphia, PA 19104 USA Case Western Reserve Univ, Ireland Canc Ctr, Cleveland, OH 44106 USA Case Western Reserve Univ Cleveland OH USA 44106 Cleveland, OH 44106 USA Hackensack Univ, Med Ctr, Hackensack, NJ USA Hackensack Univ Hackensack NJ USA sack Univ, Med Ctr, Hackensack, NJ USA Lutheran Gen Hosp, Canc Care Ctr, Div Hematol Oncol, Pk Ridge, IL USA Lutheran Gen Hosp Pk Ridge IL USA r, Div Hematol Oncol, Pk Ridge, IL USA Vanderbilt Univ, Dept Med, Nashville, TN USA Vanderbilt Univ Nashville TNUSA rbilt Univ, Dept Med, Nashville, TN USA Salick Hlth Care Inc, Div Bone Marrow & Stem Cell Transplantat, Los Angeles, CA USA Salick Hlth Care Inc Los Angeles CA USA ransplantat, Los Angeles, CA USA Univ Alabama, Bone Marrow Transplant Program, Birmingham, AL USA Univ Alabama Birmingham AL USA ow Transplant Program, Birmingham, AL USA Georgetown Univ Hosp, Bone Marrow Transplant Div, Washington, DC 20007 USAGeorgetown Univ Hosp Washington DC USA 20007 iv, Washington, DC 20007 USA
Titolo Testata:
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
fascicolo: 14, volume: 282, anno: 1999,
pagine: 1335 - 1343
SICI:
0098-7484(19991013)282:14<1335:FCWPSA>2.0.ZU;2-R
Fonte:
ISI
Lingua:
ENG
Soggetto:
BONE-MARROW SUPPORT; LONG-TERM SURVIVAL; COMBINATION CHEMOTHERAPY; AUTOLOGOUS MARROW; PROGNOSTIC FACTORS; FOLLOW-UP; PHASE-II; THIOTEPA; THERAPY; RESCUE;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
34
Recensione:
Indirizzi per estratti:
Indirizzo: Horowitz, MM Med Coll Wisconsin, Hlth Policy Inst, Breast Canc Working Comm Autologous Blood & Marro, 8701 Watertown Plank Rd,POB 26509, Milwaukee, WI 53226 USA Med Coll Wisconsin 8701 Watertown Plank Rd,POB 26509 Milwaukee WI USA 53226
Citazione:
P.A. Rowlings et al., "Factors correlated with progression-free survival after high-dose chemotherapy and hematopoietic stem cell transplantation for metastatic breast cancer", J AM MED A, 282(14), 1999, pp. 1335-1343

Abstract

Context Women with breast cancer are the most frequent recipients of high-dose chemotherapy followed by autologous hematopoietic stem cell transplantation (autotransplants) in North America. Despite widespread use, controversy exists about the benefits of and appropriate patients for this therapy. Objective To determine factors associated with disease progression or death after autotransplantation in women with metastatic breast cancer. Design Analysis of data collected retrospectively (January 1989 to 1992) and prospectively (1992 through January 1995) for the Autologous Blood and Marrow Transplant Registry. Setting Sixty-three hospitals in North America, Brazil, and Russia. Participants A total of 1188 consecutive women aged 18 to 70 years receiving autotransplants for metastatic or locally recurrent breast cancer, with a median follow-up of 29 1/2 months. Main Outcome Measure Time to treatment failure (disease progression, disease recurrence, or death) after autotransplantation. Results Factors associated with significantly (P<.05) increased risk of treatment failure in a Cox multivariate analysis included age older than 45 years (relative hazard, 1.17; 95% confidence interval [CI], 1.02-1.33), Karnofsky performance score less than 90% (1.27; 95% CI, 1.07-1.51), absence ofhormone receptors (1.31; 95% CI, 1.15-1.51), prior use of adjuvant chemotherapy (1.31; 95% CI, 1.10-1.56), initial disease-free survival interval after adjuvant treatment of no more than 18 months (1.99; 95% CI, 1.62-2.43), metastases in the liver (1.47; 95% CI, 1.20-1.80) or central nervous system(1.56; 95% CI, 0.99-2.46 [approaches significance]) vs soft tissue, bone, or lung, 3 or more sites of metastatic disease (1.32; 95% CI, 1.13-1.54), and incomplete response vs complete response to standard-dose chemotherapy (1.65; 95% CI, 1.36-1.99). Receiving tamoxifen posttransplantation was associated with a reduced risk of treatment failure in women with hormone receptor-positive tumors (relative hazard, 0.60; 95% CI, 0.47-0.87). Women with no risk factors (n = 38) had a 3-year probability of progression-free survival of 43% (95% CI, 27%-61%) vs 4% (95% CI, 2%-8%) for women with more than 3 risk factors (n = 343),Conclusion These data indicate that some women are unlikely to benefit from autotransplantation and should receive this treatment only after being provided with prognostic information and in the context of clinical trials attempting to improve outcome.

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Documento generato il 09/07/20 alle ore 13:20:26