Long-term survival after high-dose salvage chemotherapy for germ cell malignancies with adverse prognostic variables.
OBJECTIVE
Independent prognostic variables for patients undergoing high-dose chemotherapy (HDCT) as salvage modality for germ cell tumors (GCT) were previously described, and a score was created. Patients with more than 2 points had a poor prognosis. However, these data were from patients treated from 1984 to 1993, and most received a single HDCT course. In this study, we evaluated outcomes at Indiana University and determined the applicability of the Beyer score to contemporary poor-risk patients.


METHODS
We performed a retrospective analysis of patients who received salvage HDCT between 1988 and 2001 and had at least one of the following characteristics: platinum-refractory or absolutely platinum-refractory GCT, primary mediastinal nonseminomatous GCT (PMNSGCT), human chorionic gonadotropin (HCG) > or = 1,000 mU/mL or alpha-fetoprotein (AFP) > or = 1,000 ng/mL before HDCT. Primary end points were overall and 2-year failure-free survival (FFS).


RESULTS
Eighty patients were identified. Fifty-six were platinum refractory, 23 had a Beyer score greater than 2, and 13 had PMNSGCT. Fifty-six patients received two HDCT courses. HDCT included carboplatin and etoposide. Forty-three patients received HDCT as first salvage modality. Median overall survival was 14.7 months. The 2-year FFS was 32%. No relapses have occurred after 2 years from HDCT. Patients with greater than 2 points in the Beyer score, platinum-refractory patients, and patients with HCG > or = 1,000 mU/mL, AFP > or = 1,000 ng/mL, and PMNSGCT had 2-year FFS of 30%, 37%, 26%, 18%, and 0%, respectively.


CONCLUSIONS
Results with PMNSGCT remained poor. However, other patients with poor prognosis should not be denied an attempt at curative salvage HDCT.
Vaena
Daniel A
DA
Division of Hematology-Oncology, Indiana University School of Medicine and Walther Cancer Institute, Indianapolis, IN, USA.
Abonour
Rafat
R
Einhorn
Lawrence H
LH
D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012074:Remission Induction; D012189:Retrospective Studies; D016879:Salvage Therapy; D018239:Seminoma / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology; D015996:Survival Rate; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology