Presence of Cancer Cells in the Bone Marrow Not a Risk Factor in Breast Cancer Patients who Undergo Autologous Stem Cell Transplantation
According to a recent article published in the Annals of Oncology , cancer cells in the bone marrow have no impact on survival in patients with breast cancer with extensive spread of cancer to axillary (under the arm) lymph nodes who are treated with high-dose therapy and stem cell support.1
Breast cancer is a common malignancy among women in the United States. Treatment for breast cancer is becoming more streamlined to individual variables and disease factors that indicate either an increased or decreased risk of a cancer relapse. Previous studies have demonstrated that the presence of cancer cells in the bone marrow (spongy area inside of bones) is associated with a reduced survival in patients diagnosed with breast cancer.2,3,4 In addition, patients with extensive cancer spread to axillary lymph nodes also confer a reduced outcome compared to patients with either limited or no axillary lymph node spread. Researchers continually examine risk factors among women with breast cancer and the most appropriate treatment options for each patient.
High-dose therapy is a type of therapy that utilizes higher than normal doses of therapy in an attempt to kill more cancer cells than conventional therapy. Unfortunately, higher doses of therapy also tend to kill more healthy cells than lower doses, including blood cells. Low levels of blood cells leave patients susceptible to potential life-threatening infection, bleeding or anemia. Therefore, patients can have stem cells (immature blood cells) infused following therapy in order to restore blood cell levels and reduce potential problems caused by low blood cell levels. Autologous stem cell transplantation utilizes the patient’s own stem cells, which are collected prior to intense therapy, frozen and re-infused following therapy. High-dose therapy and stem cell transplantation has remained a controversial treatment option for breast cancer.
Researchers from Germany recently conducted a clinical study to evaluate the association of the presence of cancer cells in the bone marrow to outcomes in women with breast cancer and extensive axillary lymph node spread who undergo treatment with an autologous stem cell transplant. This study included 91 patients who had bone marrow samples taken prior to high-dose therapy. One-quarter of patients had cancer cells detected in the bone marrow. At a follow-up of approximately 62 months, disease-free survival and overall survival were not affected by cancer cells in the bone marrow. The strongest predictor of disease-free survival was the number of axillary nodes that the cancer had spread to and the strongest predictor of overall survival was the presence of a genetic mutation referred to as the p53 mutation.
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The researchers concluded that the presence of cancer cells in the bone marrow have no impact on survival in breast cancer patients with extensive axillary lymph node spread who undergo high-dose therapy and an autologous stem cell transplant. These results are not consistent with other results from clinical studies indicating that the presence of cancer cells in the bone marrow negatively affects survival in patients undergoing standard therapies. Patients with early breast cancer that have cancer cells in the bone marrow may wish to speak with their physician about their individual risks of a cancer recurrence following standard therapeutic approaches and the possible risks and benefits of an autologous stem cell transplant or the participation in a clinical trial evaluating novel treatment regimens. Two sources of information regarding ongoing clinical trials includes the National Cancer Institute and Cancerconnect.com. Personalized clinical trial searches are also provided on behalf of patients by CancerConnect.
1 Schneeweiss A, Diel I, Hensel M, et al. Micrometastatic bone marrow cells at diagnosis have no impact on survival of primary breast cancer patients with extensive axillary lymph node involvement treated with stem cell-supported high-dose chemotherapy. Annals of Oncology. 2004; 15: 1627-1632.
2 Gro Wiedswang, Elin Borgen, Rolf Kåresen, et al. Isolated Tumor Cells in Bone Marrow Three Years after Diagnosis in Disease-Free Breast Cancer Patients Predict Unfavorable Clinical Outcome. Clinical Cancer Research. 2004;10:5342-5348.
3 Braun S, Vogle F, Schlimok G, et al. Pooled analysis of prognostic impact of bone marrow micrometastasis: 10-year survival of 4199 breast cancer patients. Proceedings from the 2003 San Antonio Breast Cancer Symposium. December, 2003. Abstract #7.
4 Wiedswang G, Borgen E, Karensen R, et al. The presence of isolated tumor cells in bone marrow three years after diagnosis in disease free breast cancer patients predicts an unfavourable outcome. Proceedings from the 2003 San Antonio Breast Cancer Symposium. December 2003. Abstract #8.