Seventy-nine patients with metastatic breast cancer underwent examination of their bone marrow as part of their staging workup. Thirty-one (3%) showed no evidence of bone marrow involvement (BM-); 48 (61%) were found to have bone marrow metastases (BM+). Both groups of patients were treated with intensive chemotherapy with 5-FU, Adriamycin, cyclophosphamide, methotrexate, and nonspecific immunotherapy with BCG, methanol extraction residue, or Levamisole. The groups were comparable in age, race, menopausal status, and disease-free interval; however, the BM+ group had a higher proportion of patients with dominant osseous disease and a somewhat lower overall tumor burden. Ten of 21 patients in the BM + group treated with 1OO?k of the calculated dose of chemotherapy are still alive, compared with only three of 27 patients treated with lower doses. A similar dose response was observed in the BM -group. Myelosuppression was more common and more severe in the BM + group.
Hematologic support, i.e., packed erythrocytes and platelet transfusions, was required in 60% of BM+ patients, as opposed to 26% of BM -. Infectious complications were aiso higher in the BM + group, in which five episodes of sepsis and two infectious deaths were observed. These results suggest that metastatic breast cancer patients with bone marrow invasion achieve excellent palliation with aggressive high-dose chemotherapy. Higher morbidity requiring aggressive supportive care suggests that these patients should be treated by physicians and centers experienced in their management.
Cancer 48:227-232. 1981.
OMBINATION CHEMOTHERAPY programs have C proven to be effective in the management of metastatic breast cancer with response rates between 50-
80%.1-3
The presence of metastatic cancer in bone marrow has been considered a grave prognostic sign, reflecting widespread dissemination. Treatment with cytotoxic agents was once thought to be contraindicated because of decreased marrow reserve and the possibility of further marrow depression, infection, and h e m ~r r h a g e . ~, ~ However, recent reports have described success in the management of patients with breast carcinoma in bone marrow with different combination chemotherapy pro-From the Medical Breast Section,