Intensive chemotherapy with autologous peripheral blood stem cell transplantation during a 10-year period in 64 patients with germ cell tumor.
Despite gratifying cure rates in germ cell tumors, conventional-dose chemotherapy achieves long-term remissions in less than 50% of patients at high risk. High-dose chemotherapy followed by autologous (auto) peripheral blood stem cell transplantation (PBSCT) has shown impressive remission rates in high-risk and relapsed germ cell tumors. We report on 64 consecutive patients with high- (n=39), intermediate- (n=18), and refractory or relapsed low- (n=7) risk germ cell tumors who underwent auto-PBSCT between January 1993 and February 2003. PBSCTs were performed as a single (n=40) or repeated (n=24) transplantation using either etoposide, ifosfamide, and carboplatin (n=80) or related protocols (paclitaxel, ifosfamide, carboplatin, etoposide [n=7]; carboplatin, etoposide, thiotepa [n=4]). With a median follow-up of 6 years, estimated 2- and 5-year overall survivals were 77.2% (95% confidence interval [CI] 66.7-87.7) and 73.1% (95% CI 61.7-84.5), respectively. We observed unfavorable results in those patients showing refractoriness to cisplatin (hazard ratio 20.36; 95% CI 6.64-62.47) or no response to induction chemotherapy (hazard ratio 10.67; 95% CI 1.37-83.37). Auto-PBSCT was well tolerated, showed objective antitumor activity, and achieved long-term survival in patients at high risk and with relapse. Our data suggest that auto-PBSCT can increase response rates and may improve the outcome in these patients.
Müller
Antonia M S
AM
Department of Hematology and Oncology, Freiburg University Medical Center, Freiburg, Germany.
Ihorst
Gabriele
G
Waller
Cornelius F
CF
Dölken
Gottfried
G
Finke
Jürgen
J
Engelhardt
Monika
M
D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D020350:Graft vs Tumor Effect / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009373:Neoplasms, Germ Cell and Embryonal / Q000401:mortality / Q000628:therapy*; D036102:Peripheral Blood Stem Cell Transplantation / Q000401:mortality; D012307:Risk Factors; D013997:Time Factors; D014182:Transplantation, Autologous; D016896:Treatment Outcome