재발한 전이성 유방암 환자에서 고용량 Paclitaxel 화학요법 및 CD34+ 조혈모세포이식

초록

Background: Autologous hematopoietic stem cell transplantation using a positive purging method to detect CD34+ cells has a benefit of having a less chance of contamination with cancer cells in the transplanted blood containing stem cells than that using a negative purging method. And, paclitaxel is approved to be a new effective chemotherapeutic agent for breast cancer. So, the clinical results of the CD34+ hematopoietic stem cell transplantation with high-dose paclitaxel chemotherapy in the recurred metastatic breast carcinoma patients have been reported in this study. Methods: 8 patients (woman, median age: 40 years, range; 32∼59 years) with metastatic (liver, bone, lymph nodes) breast carcinoma recurred after the treatment of curative operation and adjuvant CAF (cyclophosphamide, adriamycin, 5-FU) chemotherapy, have been enrolled in this study. All patients had been responded to 4 cycles of paclitaxel (175 mg/m2 ) and ifosfamide (1,800 mg/m2 ) chemotherapy. CD34+ hematopoietic stem cells were purified from bone marrow blood by CEPRATEⓡ SC Stem Cell Concentration System using avidin-coated polyacrylamide beads column. The high-dose chemotherapy regimen was consisted with paclitaxel (625 mg/m2 ), cisplatin (165 mg/m2 ), and cyclophosphamide (5,625 mg/m2 ). The separation yield of CD34+ hematopietic stem cells, the hematopoietic recovery time, and the clinical outcomes of transplantation have been evaluated in this study. Results: The separation yield of CD34+ hematopietic stem cells with CEPRATEⓡ SC Stem Cell Concentration System was ranged from 53∼90% (median: 74%). All patients had been experienced nausea with vomiting, mucositis, central or peripheral neuropathy after high-dose paclitaxel chemotherapy. One patient had been expired due to aspiration pneumonitis. Neutropenic fever was developed in seven patients with the duration of 2∼7 (median: 4) days. The median (range) duration of neutrophil recovery to 500/ L and 2,000/ L was 11 (9∼17) and 23 (15∼ 38) days, respectively. The median (range) duration of platelet recovery to 20,000/ L and 50,000/ L was 15 (12∼23) and 18 (14∼35) days, respectively. The median follow-up duration after transplantation was 7 (3∼37) months. All patients experienced disease relapse or progression after 2-36+ months after transplantation. Therefore, overall rate of 3 year disease free survival in this study was 14.3 (1/7)%. Conclusion: CD34+ hematopoietic stem cell transplantation with high-dose paclitaxel chemotherapy in the recurred metastatic breast carcinoma patients seems to have no superior clinical outcome compared to the other modalities of high-dose chemotherapy with hematopoietic stem cell transplantation. But, we can find that high-dose paclitaxel (625 mg/m2 , dose ratio; 3.57) therapy is relatively safe in Korean patients. Therefore, further studies targeted to the recurred metastatic breast cancer patients with moderate to good prognostic factors will be warranted.

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