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June 18, 1997

Researchers Struggle With Trials of Stem-Cell Transplants for Breast Cancer

JAMA. 1997;277(23):1827-1829. doi:10.1001/jama.1997.03540470009004

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A LEADING CANCER researcher tells a story that aptlyillustrates the conflicting feelings aroused by one of the most controversial issues in oncology: whether high-dose chemotherapy (HDC) followed by a bone marrow or peripheral blood stem-cell transplant offers breast cancer patients better survival odds than conventional treatment.

"A biostatistician who was dead-set on the importance of randomized clinical trials to answer this question called me up when his sister got breast cancer to ask where she could get a transplant for sure," she said. "I have trouble with that kind of a double standard—if he's willing to put other patients on a randomized trial, then, by God, he shouldn't be finding his sister a sure transplant."

The biostatistician's behavior reflects the uneasy position that the technique currently occupies in medicine—a potentially promising but costly treatment for which there is some indication of efficacy but no definitive proof. In addition to provoking