BACKGROUND: Optimal therapy for men relapsing after initial chemotherapy for germ cell tumours (GCT) is poorly defined.
Both conventional dose salvage regimens and high-dose chemotherapy with autologous stem cell transplantation (HDCT-ASCT) have been utilised.
AIMS: To examine patients who received HDCT-ASCT for relapsed GCT within a single Australian centre.
METHODS: Records between 2000-2012 were analysed for baseline characteristics, treatment-related toxicity and survival. Prognosis at the time of HDCT-ASCT was classified according to the International Prognostic Factors Study Group (IPFSG).
RESULTS: 17 patients received HDCT-ASCT, median age 34 (21-46), with 41% having primary refractory disease and 53% with high/very high risk disease by IPFSG. The most common regimen utilised was TI-CE (paclitaxel/ifosfamide followed by high-dose carboplatin/etoposide; n=12). The median duration of Grade 4 (G4) neutropenia was 11 days (range 9-17) with febrile neutropenia in 90% resulting in 4 ICU admissions (8%). Median duration of G4 thrombocytopenia was 10 days (range 8-19) requiring a median of 2 pooled platelets bags (range 0-33) per episode. Transplant-related mortality occurred in 1 patient (veno-occlusive disease). 27% of HDCT-ASCT cycles were associated with G3 mucositis (median TPN days=5 (0-23)). 2 year PFS and OS rates were 59% and 71%. Patients who received HDCT-ASCT as 2nd or subsequent relapse fared worse than those treated with HDCT-ASCT at first relapse (hazard ratio 0.23(95% CI(0.04,1.37) p-value 0.09). 3 year OS for those who received TI-CE at first relapse was 90%.
CONCLUSIONS: HDCT-ASCT for relapsed GCT is effective with acceptable toxicity. There was encouraging PFS/OS, particularly in a poor-prognosis cohort.stem cell transplantation, testicular neoplasm, germ cell tumour, salvage therapy, autologous transplantation.
Written by:
Lewin J, Dickinson M, Voskoboynik M, Collins M, Ritchie D, Toner G. Are you the author?
DHMO, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia; Ontrac, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.
Reference: Intern Med J. 2014 Jun 3. Epub ahead of print.
doi: 10.1111/imj.12486
PubMed Abstract
PMID: 24893627
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