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Yago Nieto

Publications and source records attributed to Yago Nieto.

4 recordsLinked to original sources
PubMed2003

The verdict is not in yet. Analysis of the randomized trials of high-dose chemotherapy for breast cancer.

BACKGROUND: The relative efficacy of high-dose chemotherapy (HDC) compared to standard treatment for high-risk primary (HRPBC) or metastatic breast cancer (MBC) constitutes an area of intense controversy among the medical oncology community. A number of randomized trials have been conducted to address this issue. In most cases, the results of these trials are premature and contradictory. Furthermore, they have often been interpreted, incorrectly in this author's judgment, as proof of lack of benefit of HDC. EVIDENCE AND INFORMATION SOURCES: The results of studies published in peer-reviewed medical journals or presented in scientific meetings are discussed. In some cases, the status of the studies was determined through direct communication with the trial's principal investigator. RESULTS: The encouraging results of phase II trials suggested a benefit for HDC in important categories of patients with breast cancer. It has been argued that selection of patients might have been a critical factor in those studies. The results, in most cases preliminary, of numerous randomized trials in metastatic and high-risk primary disease cannot offer a definitive answer to this crucial question as of yet. Important concepts in the interpretation of these studies, such as size and statistical power, length of follow-up, magnitude of clinical benefit, and broad applicability of the results, are discussed in this review. CONCLUSIONS: The role of HDC for HRPBC or MBC patients remains undefined. Longer follow-up and mature analyses of the randomized trials are necessary before definitive conclusions are drawn. In the meantime, it is imperative that research continues, to enhance the efficacy of the procedure through innovative strategies.

Antineoplastic Agents↗
PubMed2002

Prognostic model for relapse after high-dose chemotherapy with autologous stem-cell transplantation for stage IV oligometastatic breast cancer.

PURPOSE: To study prognostic factors after high-dose chemotherapy (HDC) for patients with stage IV oligometastatic breast cancer. PATIENTS AND METHODS: Sixty patients with minimal metastatic disease amenable to local therapy enrolled onto a prospective HDC trial were analyzed for potential prognostic factors. Tumor blocks were retrospectively collected from referring institutions. RESULTS: Median follow-up was 62 months (range, 4 to 120 months). Median relapse-free survival (RFS) and overall survival (OS) times were 52 and 80 months, respectively. Five-year RFS and OS rates were 52% (95% confidence interval [CI], 39% to 64%) and 62% (95% CI, 49% to 74%), respectively. HER-2 expression, number of tumor sites, primary axillary nodal ratio (number of positive nodes divided by number of sampled nodes), number of positive axillary nodes, and delivery or omission of radiotherapy to metastases correlated with RFS. HER-2 overexpression and more than one site were independent adverse risk factors for RFS. HER-2 and the axillary nodal ratio were independent predictors of OS. The following prognostic categories for RFS were established (RFS rate, median RFS): good risk, no factors (77%, 80 months); intermediate risk, one factor (41%, 28 months); and poor risk, both factors (10%, 10 months). CONCLUSION: Long-term results in patients with oligometastatic breast cancer are encouraging but need validation in prospective randomized studies. HER-2 expression, number of sites, and primary nodal ratio are independent outcome predictors. Confirmation of these observations in this selected population would imply the need for reevaluation of the current tenet that early detection of metastatic breast cancer recurrence is of no benefit.

Adult↗
PubMed2002

Transplantation of ex vivo expanded cord blood.

Umbilical cord blood (CB) from unrelated donors is increasingly used to restore hematopoiesis after myeloablative therapy. CB transplants are associated with higher rates of delayed and failed engraftment than are bone marrow transplants, particularly for adult patients. We studied the ex vivo expansion of CB in an attempt to improve time to engraftment and reduce the graft failure rate in the recipients. In this feasibility study, 37 patients (25 adults, 12 children) with hematologic malignancies (n = 34) or breast cancer (n = 3) received high-dose therapy followed by unrelated allogeneic CB transplantation. A fraction of each patient's CB allograft was CD34-selected and cultured ex vivo for 10 days prior to transplantation in defined media with stem cell factor, granulocyte colony-stimulating factor, and megakaryocyte growth and differentiation factor. The remainder of the CB graft was infused without further manipulation. Two sequential cohorts of patients were accrued to the study. The first cohort had 40% and the second cohort had 60% of their CB graft expanded. Patients received a median of 0.99 x 10(7) total nucleated cells (expanded plus unexpanded) per kilogram. The median time to engraftment of neutrophils was 28 days (range, 15-49 days) and of platelets was 106 days (range, 38-345 days). All evaluable patients who were followed for 28 days or longer achieved engraftment of neutrophils. Grade III/IV acute GVHD was documented in 40% and extensive chronic GVHD in 63% of patients. At a median follow-up of 30 months, 13 (35%) of 37 of patients survived. This study demonstrates that the CD34 selection and ex vivo expansion of CB prior to transplantation of CB is feasible. Additional accrual will be required to assess the clinical efficacy of expanded CB progenitors.

Adolescent↗