The use of stem cell transplantation in breast cancer treatment soared in the early and mid 1990s but the dramatic fall that begin in 1997 as clinical trials showed it appeared to be of little benefit continues, according to new figures published in the journal Annals of Oncology.

Nearly 28,000 stem cell transplants were carried out for various types of solid tumors in Europe between 1991 and 2002. Breast cancer accounted for around half of the procedures (more than 13,500). Breast cancer transplants rose from 94 in 1991 to 2,629 in 1997 on the back of promising results from phase II clinical trials where transplants were combined with high-dose chemotherapy. But, as phase III trial results showed the treatment was failing to live up to earlier hopes, they dropped dramatically and the latest figures show that they were down to 330 in 2002.

The findings are from a survey carried out by an international team on behalf of the Accreditation Committee of the European Group for Blood and Marrow Transplantation (EBMT) and in co-operation with the Working Party on Solid Tumors and the Working Party on Paediatric Diseases.

Seven other specific types of solid tumors - germ cell cancer (12%), neuroblastoma (9%), Ewing's sarcoma (7%), soft tissue sarcoma (4%), ovarian cancer (3%) glioma (2%) and lung cancer (1%), plus 'others' (13%) - made up the transplant total. Ninety-eight percent of the transplants were autologous (from the patient's own bone marrow) and two percent were allogenic (from donors).

Lead author Professor Alois Gratwohl from the Department of Internal Medicine at Kantonsspital Basel in Switzerland, said: "In the early and mid-1990s impressive data from phase II trials as well as from registries accelerated the growth in the number of autotransplants for breast cancer. When the first results from phase III studies become available a wave of pessimism began to appear and the numbers undergoing high-dose chemotherapy began to drop. Most recent results remain ambiguous and the value of stem cell transplant in breast cancer still needs to be determined in selected categories. But, it might be an effective tool in treating some subsets of patients. What is encouraging is that the fall in the numbers of stem cell transplants illustrates that doctors have been quick to react to the negative findings in the trials and to share that information."

SOURCE:
Annals of Oncology, April 2004