High-Dose Chemotherapy in Breast Cancer

In 1891 Brown-Sequard attempted to augment human bone marrow orally [1]. Over the next five decades allogeneic marrow was administered intramuscularly [2] and by intramedullary injection [3], before the intravenous route was found to be optimal in 1939 [4]. Between 1945 and 1965 the effects of total body radiotherapy were studied and the immunocompatibility complex was identified. The first series of patients transplanted for relapsed leukemia and aplastic anemia was published in 1968 [5]. In 1977, Thomas and colleagues in Seattle reported that 13 of 100 patients with relapsed acute leukemia at the time of transplant were disease free 1–4.5 years later [6]. Today more than half of acute myelogenous leukemia patients transplanted during first remission with HLA-matched sibling donor marrow are now cured [7–8]. Substantial gains made in the prevention of graft-versus-host disease and in supportive care (platelet transfusions and a wider variety of effective antibiotics) have considerably decreased the risks of high dose therapy.