High-Dose Chemotherapy and Autologous Hematopoietic Stem Cell Transplantation as Adjuvant Treatment in High-Risk Breast Cancer: Data from the European Group for Blood and Marrow Transplantation Registry

Biol Blood Marrow Transplant. 2016 Mar;22(3):475-81. doi: 10.1016/j.bbmt.2015.12.011. Epub 2015 Dec 23.


The aim of this retrospective study was to assess toxicity and efficacy of adjuvant high-dose chemotherapy (HDC) and autologous hematopoietic stem cell transplantation (AHSCT) in 583 high-risk breast cancer (BC) patients (>3 positive nodes) who were transplanted between 1995 and 2005 in Europe. All patients received surgery before transplant, and 55 patients (9.5%) received neoadjuvant treatment before surgery. Median age was 47.1 years, 57.3% of patients were premenopausal at treatment, 56.5% had endocrine-responsive tumors, 19.5% had a human epidermal growth factor receptor 2 (HER2)-negative tumor, and 72.4% had ≥10 positive lymph nodes at surgery. Seventy-nine percent received a single HDC procedure. Overall transplant-related mortality was 1.9%, at .9% between 2001 and 2005, whereas secondary tumor-related mortality was .9%. With a median follow-up of 120 months, overall survival and disease-free survival rates at 5 and 10 years in the whole population were 75% and 64% and 58% and 44%, respectively. Subgroup analysis demonstrated that rates of overall survival were significantly better in patients with endocrine-responsive tumors, <10 positive lymph nodes, and smaller tumor size. HER2 status did not affect survival probability. Adjuvant HDC with AHSCT has a low mortality rate and provides impressive long-term survival rates in patients with high-risk BC. Our results suggest that this treatment modality should be considered in selected high-risk BC patients and further investigated in clinical trials.

Keywords: Autologous hematopoietic stem cell transplantation; High-dose chemotherapy; High-risk breast cancer.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • Autografts
  • Breast Neoplasms / mortality*
  • Breast Neoplasms / therapy*
  • Chemotherapy, Adjuvant / methods
  • Disease-Free Survival
  • Europe / epidemiology
  • Female
  • Hematopoietic Stem Cell Transplantation*
  • Humans
  • Middle Aged
  • Registries
  • Survival Rate