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目的:高复发风险乳腺癌患者术后复发率高。目前,对于外周血干细胞移植支持下大剂量化疗在乳腺癌辅助治疗中的应用价值仍存有争议。本研究旨在探讨高复发风险乳腺癌患者术后接受外周血自体干细胞移植支持下大剂量化疗的疗效和安全性。方法:对24例高复发风险乳腺癌术后患者给予紫杉醇(175mg/m2)和粒细胞集落刺激因子(granulocyte colony-stimulating factor,G-CSF)(5μg/kg)以动员和采集外周血CD34+造血干细胞,然后进行2个周期的大剂量化疗,其中11例患者接受三药联合化疗方案[紫杉醇175mg/m2、塞替哌150mg/m2联合卡铂(设定血药浓度-时间曲线下面积=6,计算给药剂量为300mg/m2,分2d给药)],13例接受双药联合化疗方案(紫杉醇175mg/m2联合塞替哌150mg/m2)。化疗开始后第2天给予CD34+造血干细胞回输,第3天开始使用G-CSF,直至患者外周血白细胞计数连续3d均>10.0×109/L。观察大剂量化疗不良反应。计算中位无病生存(disease-free survival,DFS)期和3年DFS率。结果:中位随访期为32个月(3～62个月),中位DFS为32个月,3年DFS率为56.3%。大剂量化疗安全性良好,无治疗相关性死亡。结论:自体外周血造血干细胞移植支持下大剂量紫杉醇联合塞替哌化疗方案辅助治疗高复发风险乳腺癌术后患者的安全性良好,其DFS获益优于常规剂量辅助化疗。
Objective: High recurrence risk of breast cancer patients with high recurrence rate. At present, there is still controversy about the value of high-dose chemotherapy supported by peripheral blood stem cell transplantation in the adjuvant treatment of breast cancer. This study was designed to investigate the efficacy and safety of high-dose chemotherapy with high-recurrence-risk breast cancer patients undergoing peripheral blood stem cell transplantation. METHODS: Twenty-four patients with high-risk breast cancer were treated with paclitaxel (175 mg / m2) and granulocyte colony-stimulating factor (G-CSF) (5 μg / kg) to mobilize and collect peripheral blood CD34 + Stem cells were treated with two cycles of high-dose chemotherapy followed by 11 cycles of triple-agent chemotherapy (paclitaxel 175 mg / m2, cetirizine 150 mg / m2 plus carboplatin (set the area under the plasma concentration-time curve = 6 , Calculated dose of 300mg / m2, administered 2d)], 13 patients received dual-drug combination chemotherapy (paclitaxel 175mg / m2 combined with cetirizine 150mg / m2). On the second day after chemotherapy, CD34 + hematopoietic stem cells were transfused, and G-CSF was started on the third day until the peripheral white blood cell count of patients was> 10.0 × 109 / L for three consecutive days. To observe the high-dose chemotherapy adverse reactions. The median disease-free survival (DFS) and 3-year DFS rates were calculated. Results: The median follow-up period was 32 months (range 3 to 62 months). The median DFS was 32 months and the 3-year DFS rate was 56.3%. High-dose chemotherapy is safe and there is no treatment-related death. CONCLUSIONS: High-dose paclitaxel combined with sertraline chemotherapy is a safe and effective adjuvant therapy for patients with high-risk recurrence of breast cancer after autologous peripheral blood stem cell transplantation. The benefit of DFS is superior to that of conventional adjuvant chemotherapy.