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Prolonged survival associated with early lymphocyte recovery after autologous hematopoietic stem cell transplantation for patients with metastatic breast cancer

Bone Marrow Transplantation volume 31, pages 141–142 (2003)Cite this article

Recently, Porrata et al1 reported in this journal a retrospective analysis of the absolute lymphocyte count (ALC) in patients with metastatic breast cancer treated with high-dose chemotherapy (HD-CT) followed by autologous stem cell transplantation (ASCT). They found that ALC counts of ⩾500 cells/μl on day 15 post-ASCT predicted a significant better overall (OS) and disease-free survival (DFS). A total of 29 patients with metastatic breast cancer were included in two different studies, both using STAMP V as a high-dose treatment regimen (cyclophosphamide 1.5 g/m2/day; carboplatin 200 mg/m2/day and thiotepa 125 mg/m2/day on 4 consecutive days). The ALC threshold for immunologic engraftment was determined at 500 cells/μl on day 15 of transplantation based on experience with hematologic malignancies. After a median follow-up of 2.25 years for living patients (minimum follow-up 2 years or until death), they reported a significantly better median OS and DFS in the 20 patients with ALC ⩾500 cells/μl than in the nine patients with ALC ⩾500 cells/μl on day 15 post-ASCT (not reached vs 14 months P<0.0001; 24 vs 7 months P<0.0015, respectively).

Recently, we published a phase II study of multiple courses of HD-CT with ASCT in 41 patients with stage IV breast cancer.2 Our high-dose regimen consists of the same agents as STAMP V, but was administered at different doses over multiple courses. As our patient group was quite similar to the patient group described by Porrata et al,1 we analyzed the lymphocyte count at day 15 after the last course of HD-CT with ASCT in our patient group. We also analyzed ALC before the start of chemotherapy, because one could argue that the patients with a lower ALC at day 15 post-ASCT already had lower values at the start of therapy because of bone marrow infiltration. These patients could have a worse prognosis owing to tumor invasion in the bone marrow.

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References

  1. Porrata LF, Ingle JN, Litzow MR et al. Prolonged survival associated with early lymphocyte recovery after autologous hematopoietic stem cell transplantation for patients with metastatic breast cancer. Bone Marrow Transplant 2001; 28: 865–871.

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  2. Schrama JG, Baars JW, Holtkamp MJ et al. Phase II study of a multi-course high-dose chemotherapy regimen incorporating cyclophosphamide, thiotepa, and carboplatin in stage IV breast cancer. Bone Marrow Transplant 2001; 28: 173–180.

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  3. De Gast GC, Vyth-Dreese FA, Nooijen W et al. Reinfusion of autologous lymphocytes with granulocyte-macrophage colony-stimulating factor induces rapid recovery of CD4+ and CD8+ T cells after high-dose chemotherapy for metastatic breast cancer. J Clin Onc 2002; 1: 58–64.

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  1. Division of Medical Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 1066CX, The Netherlands

    J G Schrama, S Rodenhuis & G C de Gast

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  1. J G Schrama
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  2. S Rodenhuis
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  3. G C de Gast
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Schrama, J., Rodenhuis, S. & de Gast, G. Prolonged survival associated with early lymphocyte recovery after autologous hematopoietic stem cell transplantation for patients with metastatic breast cancer. Bone Marrow Transplant 31, 141–142 (2003). https://doi.org/10.1038/sj.bmt.1703801

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