High-dose chemotherapy with autologous PBSC transplantation for poor prognosis germ cell tumors: a retrospective monocenter analysis of 44 cases

Abstract

Germ cell cancer (GCC) is curable in metastatic stages. The International Germ Cell Cancer Collaborative Group (IGCCCG) reports a poor prognosis subgroup with a 5-year survival of 48%. High-dose chemotherapy with PBSC transplantation (HD-PBSCT) in these patients showed promising results in phase II, but failed to show significant advantage in randomized trials. We report our monocenter series of all poor and selected intermediate prognosis germ cell tumor patients treated with multiple-course HD-PBSCT and secondary surgery of remaining tissue. We performed a retrospective analysis of our complete series of 44 patients (40 poor prognosis and 4 intermediate prognosis) treated by HD-PBSCT as part of first-line therapy from 1999 to 2010. The CR rate after up to four cycles of HD-PBSCT and radical resection of residual manifestations was 73%. The 3-year survival rate was 79.5% (median follow-up of 51.5 months; range: 7 --143 months). Disease-related death rate was 16%. HD-PBSCTrelated death did not occur. One patient died postsurgery. Multiple courses of HD-PBSCT with radical secondary surgery is safe and effective in poor prognosis metastatic GCC. Despite disappointing phase III studies it is of high interest to further study this field.

Treating relapsed and refractory metastatic germ cell tumours with high-dose chemotherapy with carboplatin and etoposide and autologous haematopoietic stem cell transplantation

“…demonstrated that the CR, PR and refractory disease rates in patients with GCTs in the intermediate or poor-risk groups, as defined by the IGCCCG, were approximately 50%, 36% and 14%, respectively. 14 Contrarily, Vaena et al. reported lower response rates with higher mortality rates for the GCT patients in the intermediate or poor-risk groups.…”

Retrospective analysis of patients with relapsed or refractory germ cell tumors treated with autologous hematopoietic stem cell transplantation

“…According to the literature, most of the studies consist nonhomogenous groups like our study. Mohr M et al presented in a retrospective analysis of patients with poor or intermediate prognostic factors according to the IGCCCG with GCT CR, PR, and refractory disease were approximately 50%, 35%, and 15%, respectively (15). Additionally, Vaena et al reported lower response rates with higher mortality rates (8).…”

A Retrospective Study of Patients with Recurrent or Refractory Testicular Germ Cell Tumors Treated with High-dose Chemotherapy and Autologous Peripheral-blood Stem-cell Transplantation Single-center Experience

“…It can be performed as a first-line, second-line therapy or it can be an alternative therapy in heavily treated refractory patients. Although high-survival rates (more than 70%) were documented in the literature when ASCT was performed as first-line therapy in patients with poor prognostic factors (14), the role of ASCT as a first-line treatment in patients with poor prognostic markers is not clear. The International Prognostic Factors Study Group offered data of 1594 patients with GCT, who have progressed after at least three cycles of cisplatin-based chemotherapy.…”

“…PR was defined as PET/CT of the disease with an evidence of response. PR was divided into PR with negative tumor markers (tumor markers within normal range) and PR with positive tumor markers (high tumor marker levels) (14). Progressive disease (PD) was accepted as more than 25% increase in PET/ CT measurable mass or more than 10% increase of elevated tumor markers.…”