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September 23, 1992

High-Dose Chemotherapy With Autologous Bone Marrow Transplantation for Metastatic Breast Cancer

Author Affiliations

Duke University Durham, NC
Medical College of Virginia Richmond

JAMA. 1992;268(12):1536-1537. doi:10.1001/jama.1992.03490120050014

To the Editor.  —The April 15 issue of JAMA contained an evaluation of the cost-effectiveness of high-dose chemotherapy with autologous bone marrow transplantation (ABMT) for metastatic breast cancer.1 Simultaneously, another article evaluating the same treatment was published in the Journal of Clinical Oncology.2 At first glance, the two articles appear to reach opposite conclusions. As the authors of the two articles, we thought it would be helpful to reconcile the apparently different conclusions.The Journal of Clinical Oncology article2 was a comprehensive literature review. Its main conclusions were that (1) there are no well-controlled studies documenting that high-dose chemotherapy with ABMT is superior to conventional care, and (2) a crude comparison of clinical series reveals that the two treatments have essentially the same median survival rates (16.2 months for conventional care vs 16 months for high-dose chemotherapy with ABMT), median disease-free survival rates (8.8 months vs 8.3