title: Utility of single versus tandem autotransplants for advanced testes/germ cell cancer: a center for international blood and marrow transplant research (CIBMTR) analysis.
abstract: Tandem autotransplants are used to treat advanced testis cancer patients but their value compared to a single autotransplant is unknown. To evaluate the results of autotransplant in relapsed testicular/germ cell cancer, data from 300 patients undergoing autotransplants 1989-2002 were reported to the Center for International Blood and Marrow Transplant Research. We compared results for those patients intended to undergo tandem autotransplant procedures (N = 102) versus patients in whom a second autotransplant was not planned (N = 198). Five-year survival probability was 35% (95% confidence interval = 25%-46%) in the planned tandem transplant cohort compared to 42% (35%-49%) in the group not planned to have a second transplant (P = .29). Probability of progression-free survival at 5 years for these cohorts was 34% (25%-44%) and 38% (31%-45%), respectively (P = .50). The planned tandem autotransplant cohort had significantly more advanced disease at diagnosis and greater likelihood of cisplatin resistance. Patients intended to receive tandem transplants had a lower treatment-related mortality at 1 year (3% versus 10%, P = .02). Using propensity score analysis the planned tandem autotransplant cohort had significantly lower treatment-related mortality (P = .044) but no different risk of relapse (P = .541) compared to the planned single transplant cohort. Tandem autotransplants for testicular cancer are associated with less treatment-related mortality than a planned single transplant, with no differences in disease-related outcomes or overall survival at 3 years. Patient selection bias for either transplant approach, however, may affect the results of this observational study; a randomized trial is needed to determine which approach, if either, is better.
authors.affiliation: University Hospitals of Cleveland, Cleveland, Ohio 44106, USA. hillard.lazarus@case.edu <hillard.lazarus@case.edu>
authors.forename: Hillard M
authors.initials: HM
authors.lastname: Lazarus
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Stiff
authors.forename: Jeanette
authors.initials: J
authors.lastname: Carreras
authors.forename: Brent R
authors.initials: BR
authors.lastname: Logan
authors.forename: Luke
authors.initials: L
authors.lastname: Akard
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Bolwell
authors.forename: Richard W
authors.initials: RW
authors.lastname: Childs
authors.forename: Robert Peter
authors.initials: RP
authors.lastname: Gale
authors.forename: John P
authors.initials: JP
authors.lastname: Klein
authors.forename: Michael C
authors.initials: MC
authors.lastname: Lill
authors.forename: Waleska S
authors.initials: WS
authors.lastname: Pérez
authors.forename: Edward A
authors.initials: EA
authors.lastname: Stadtmauer
authors.forename: J Douglas
authors.initials: JD
authors.lastname: Rizzo
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage; D002945:Cisplatin / Q000008:administration & dosage; D018572:Disease-Free Survival; D019008:Drug Resistance, Neoplasm / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009373:Neoplasms, Germ Cell and Embryonal / Q000401:mortality* / Q000628:therapy; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D033581:Stem Cell Transplantation; D015996:Survival Rate; D013736:Testicular Neoplasms / Q000401:mortality* / Q000628:therapy; D014182:Transplantation, Autologous
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin