High dose chemotherapy and autologous bone marrow or stem cell transplantation versus conventional chemotherapy for women with early poor prognosis breast cancer

Farquhar C, Marjoribanks J, Basser R, Lethaby A

Published Online:

October 8, 2008

There is no evidence to show that women with early poor-prognosis breast cancer live longer if they undergo high-dose chemotherapy with stem cell transplantation. Women with breast cancer who have multiple positive lymph nodes when first diagnosed are at high risk of recurrence. Conventional chemotherapy has limited success and is unsafe in high doses as it damages the bone marrow. One treatment considered promising was to give women very high doses of chemotherapy followed by transplantation of stem cells to regenerate their bone marrow. A review of thirteen studies reported that the high-dose treatment did not increase overall survival compared with conventional treatment, although disease recurred less frequently within the first three or four years. Treatment -related deaths were more frequent and side-effects were more severe in the high-dose group.

Abstract (click to read)

Background:

Overall survival rates are disappointing for women with early poor prognosis breast cancer. Autologous transplantation of bone marrow or peripheral stem cells (in which the patient is both donor and recipient) has been considered a promising technique because it permits use of much higher doses of chemotherapy.

Objectives:

To compare the effectiveness of high dose chemotherapy and autograft versus conventional chemotherapy for women with early poor prognosis breast cancer. Outcomes were survival rates, toxicity and quality of life.

Search strategy:

We searched the Cochrane Breast Cancer Group specialised register, The Cochrane Controlled Trials Register (Cochrane Library Issue 2, 2006), MEDLINE (1966 to September 2006), EMBASE (1980 to September 2006), PsycINFO (1984 to September 2006), Cinahl (1982 to September 2006), web sites of co-operative research groups and ASCO (American Society of Clinical Oncologists) and reference lists of articles found.

Selection criteria:

Randomised controlled trials comparing high dose chemotherapy and autograft versus conventional chemotherapy for women with early poor prognosis breast cancer.

Data collection and analysis:

Thirteen trials were included.

Main results:

Analysis included 2535 women randomised to receive high dose chemotherapy with autograft and 2529 randomised to receive conventional chemotherapy. There were 65 treatment-related deaths on the high dose arm and four on the conventional dose arm (RR 8.58 (95% CI 4.13, 17.80).

Some studies have not completed follow-up and much of the data is not fully mature. There was a statistically significant benefit in event-free survival for women in the high dose group at three years (RR 1.19 (95% CI 1.06, 1.19)) and at four years (RR 1.24 (95% CI 1.03, 1.50)) and at five years there was a benefit for the high dose group that approached statistical significance (RR 1.06 (95% CI 1.00, 1.13) . With respect to overall survival, there was no statistically significant difference between the groups at any stage of follow up.

Morbidity was more common and more severe in the high dose group. However there was no statistically significant difference between the groups in the incidence of second cancers at five to seven years' median follow up. Women in the high dose group reported significantly worse quality of life scores immediately after treatment, but few statistically significant differences were found between the groups by one year.

Authors' conclusions:

There is insufficient evidence to support the routine use of high dose chemotherapy with autograft for women with early poor prognosis breast cancer.

This record should be cited as:

Farquhar C, Marjoribanks J, Basser R, Lethaby A. High dose chemotherapy and autologous bone marrow or stem cell transplantation versus conventional chemotherapy for women with early poor prognosis breast cancer. Cochrane Database of Systematic Reviews 2005, Issue 3. Art. No.: CD003139. DOI: 10.1002/14651858.CD003139.pub2

Assessed as up to date:

September 19, 2006

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Primary Review Group:

Breast Cancer Group

Health topics:

Cancer > Breast > Chemotherapy

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

High dose chemotherapy and autologous bone marrow or stem cell transplantation versus conventional chemotherapy for women with early poor prognosis breast cancer

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