High dose chemotherapy and autologous bone marrow or stem cell transplantation versus conventional chemotherapy for women with early poor prognosis breast cancer

摘要: Background Overall survival rates are disappointing for women with early poor prognosis breast cancer. Autologous transplantation of bone marrow or peripheral stem cells (in which the woman is both donor and recipient) has been considered a promising technique because it permits use much higher doses chemotherapy. Objectives To compare effectiveness safety high-dose chemotherapy autograft (either autologous cell transplantation) conventional cancer. Search methods We searched Cochrane Breast Cancer Group Specialised Register, MEDLINE (1966 to October 2015), EMBASE (1980 World Health Organization's International Clinical Trials Registry Search Platform, ClinicalTrials.gov on 21 2015. Selection criteria Randomised controlled trials (RCTs) comparing (bone transplant rescue) versus without cancer. Data collection analysis Two review authors selected RCTs, independently extracted data assessed risks bias. We combined using Mantel-Haenszel fixed-effect model calculate pooled risk ratios (RRs) 95% confidence intervals (CIs). quality evidence GRADE methods. Outcomes were rates, toxicity life. Main results We included 14 RCTs 5600 randomised receive The studies at low bias in most areas. There high-quality that does not increase likelihood overall any stage follow-up (at three years: RR 1.02, CI 0.95 1.10, 3 795 women, I² = 56%; five 1.00, 0.96 1.04, 9 3948 0%; six 0.94, 0.81 1.08, 1 RCT, 511 women; eight RR1.17, 1.43, 344 12 1.18, 0.99 1.42, 382 women). There improves event-free years (RR 1.19, 1.06 1.34, 56%) but this effect was no longer apparent duration 1.09, 14%; 0.87 1.24, 1.27, 1.64, 1.45, women). Treatment-related deaths more frequent arm 7.97, 3.99 15.92, 12%, evidence) non-fatal morbidity also common severe group. There little difference between groups incidence second cancers four nine years' median 1.25, 0.90 1.73, 7 3423 0%, evidence). Women group reported significantly worse quality-of-life scores immediately after treatment, there few statistically significant differences by one year. The primary areas, methods rated as high all comparisons. Authors' conclusions There increased treatment-related mortality