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Original Summaries of Selected CANCERLIT Abstracts.
Contamination by Tumor Cells in Bone Marrow or Stem Cell Transplantation
Last modified on:
Tuesday, April 20, 1999 10:52:30
Copyright © 1994-2008, Information Ventures, Inc.
The prognosis of primary breast cancer involving more than ten
axillary lymph nodes remains poor despite the use of high-dose
chemotherapy (HDC), with hematopoietic support by transplantation
of either bone marrow or peripheral blood stem cells (PBSC).
Patients undergoing HDC with hematopoietic rescue may have tumor
cells inadvertently reinfused if the harvested blood products
contain these cells. Could the poor results be due to
contaminating cells? The issue was addressed from three different
angles in the November CANCERLIT update. In the first study, a
group at Duke University in Durham, NC, investigated patients after
four cycles of chemotherapy (Vredenburgh; ICDB/95614084). Of 71
bone marrows tested, 42% still had cells positive for breast cancer
antigens. Of 50 PBSC samples tested, 4% were contaminated with
breast-cancer-antigen positive cells. Univariate analysis
indicated that the presence of such cells was predictive of relapse
(p = 0.04) and survival (p = 0.02), whereas by multivariate
analysis, bone marrow micrometastases were not a significant
predictor of either relapse or survival.
In the second study (Brockstein; ICDB/95614127 ) from the University of Chicago, 29
bone marrow and two PBSC specimens were taken from women with
advanced stage breast cancer at the time of bone marrow harvest
prior to HDC. All patients achieved partial or complete remission
on one of three consecutive HDC protocols and received bone marrow
or marrow and PBSCs. Six of 26 evaluable patients had detectable
contaminating tumor cells. These six showed a trend towards
decreased overall survival compared to those with no detectable
tumor cells (median of 17 months versus more than 25 months, p =
0.11, log rank test, for those patients achieving complete
remission). However, relapse patterns suggested that failures
occurred only at the sites of previous disease. These two studies
suggested an effect of contamination, but were unable to confirm
that it is a major clinical problem. Further large definitive
studies would be needed to justify the expense and effort of
eliminating all tumor cells from marrow and PBSC preparations. The
third study from the Johns Hopkins Oncology Center in Baltimore
(Passos-Coelho; ICDB/95614068) showed a low incidence of breast
cancer cell contamination of single PBSC collections after priming
with hematopoietic cytokine alone or with cytokine and cyclophosphamide.
November, 1995
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