TY - JOUR
T1 - Predicting outcome based on Swenerton score in patients with metastatic breast cancer undergoing high-dose chemotherapy and autologous hematopoietic stem cell transplantation
T2 - Implications for patient selection
AU - Montemurro, Filippo
AU - Randón, Gabriela
AU - Munsell, Mark
AU - Smith, Terry L.
AU - Donato, Michele L.
AU - Gajewski, James L.
AU - Rahman, Zia U.
AU - Buzdar, Aman U.
AU - Champlin, Richard E.
AU - Ueno, Naoto T.
N1 - Funding Information:
Filippo Montemurro was also supported by a grant from the Institute for Cancer Research and Treatment, Ordine Mauriziano, Candiolo, Torino, Italy.
PY - 2003/5
Y1 - 2003/5
N2 - The aim of this study was to study the effectiveness of the Swenerton score in assessing extent of disease as an independent prognostic and predictive factor in patients with metastatic breast cancer (MBC) who receive high-dose chemotherapy (HDCT) with autologous hematopoietic stem cell transplant (AHSCT). Two-hundred thirty-two patients with MBC underwent HDCT. Extent of disease was assessed quantitatively using the Swenerton score. A retrospective analysis was performed using Cox proportional hazards regression and logistic regression models. One hundred three (44%) patients had a complete response (CR) after HDCT. Bone marrow as source of hematopoietic stem cells, hormone-receptor-negative status, and visceral involvement correlated with both worse overall survival (OS) and progression-free survival (PFS). Short disease-free interval, multiple sites of metastatic disease, and less than 50% reduction in the Swenerton Score during induction chemotherapy correlated with worse OS. Patients in CR at the time of HDCT had better PFS than patients in partial response, stable disease, or progressive disease. Fifty-six patients who underwent conversion to CR after HDCT had a similar median OS (not reached v 74 months; P = .51) and PFS duration (22 v 44 months; P = .15) as patients who received HDCT after a CR to standard-dose chemotherapy (SDCT). Conversion to CR was predicted by a ≥50% reduction in the Swenerton score during SDCT (odds ratio [OR] 3.32, P < .01) and soft-tissue disease (OR 4.08, P < .01). The presence of multiple metastatic sites predicted decreased probability of conversion to CR (OR 0.34, P < .01). The Swenerton score provides a thorough estimate of disease extent, and reduction of Swenerton score by SDCT is potentially useful for selecting the optimal candidates for HDCT trials who may achieve long-term disease control.
AB - The aim of this study was to study the effectiveness of the Swenerton score in assessing extent of disease as an independent prognostic and predictive factor in patients with metastatic breast cancer (MBC) who receive high-dose chemotherapy (HDCT) with autologous hematopoietic stem cell transplant (AHSCT). Two-hundred thirty-two patients with MBC underwent HDCT. Extent of disease was assessed quantitatively using the Swenerton score. A retrospective analysis was performed using Cox proportional hazards regression and logistic regression models. One hundred three (44%) patients had a complete response (CR) after HDCT. Bone marrow as source of hematopoietic stem cells, hormone-receptor-negative status, and visceral involvement correlated with both worse overall survival (OS) and progression-free survival (PFS). Short disease-free interval, multiple sites of metastatic disease, and less than 50% reduction in the Swenerton Score during induction chemotherapy correlated with worse OS. Patients in CR at the time of HDCT had better PFS than patients in partial response, stable disease, or progressive disease. Fifty-six patients who underwent conversion to CR after HDCT had a similar median OS (not reached v 74 months; P = .51) and PFS duration (22 v 44 months; P = .15) as patients who received HDCT after a CR to standard-dose chemotherapy (SDCT). Conversion to CR was predicted by a ≥50% reduction in the Swenerton score during SDCT (odds ratio [OR] 3.32, P < .01) and soft-tissue disease (OR 4.08, P < .01). The presence of multiple metastatic sites predicted decreased probability of conversion to CR (OR 0.34, P < .01). The Swenerton score provides a thorough estimate of disease extent, and reduction of Swenerton score by SDCT is potentially useful for selecting the optimal candidates for HDCT trials who may achieve long-term disease control.
KW - Autologous transplantation
KW - Breast neoplasm
KW - High-dose chemotherapy
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U2 - 10.1016/S1083-8791(03)00088-0
DO - 10.1016/S1083-8791(03)00088-0
M3 - Article
C2 - 12766883
AN - SCOPUS:12144289539
SN - 1083-8791
VL - 9
SP - 330
EP - 340
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
IS - 5
ER -