title: Prognostic impact of progression to induction chemotherapy and prior paclitaxel therapy in patients with germ cell tumors receiving salvage high-dose chemotherapy in the last 10 years: a study of the European Society for Blood and Marrow Transplantation Solid Tumors Working Party.
abstract: Little is known about the prognostic impact of prior paclitaxel therapy and response to induction chemotherapy defined as the regimen preceding high-dose chemotherapy (HDCT) for the salvage therapy of advanced germ cell tumors. Twenty European Society for Blood and Marrow Transplantation centers contributed data on patients treated between 2002 and 2012. Paclitaxel used in either prior lines of therapy or in induction-mobilization regimens was considered. Multivariable Cox analyses of prespecified factors were undertaken on PFS and overall survival (OS). As of October 2013, data for 324 patients had been contributed to this study. One hundred and ninety-two patients (59.3%) had received paclitaxel. Sixty-one patients (19%) had a progression to induction chemotherapy, 234 (72%) a response (29 (9%) missing or granulocyte colony-stimulating factor without chemotherapy). Both progression to induction chemotherapy and prior paclitaxel were significantly associated with shorter OS univariably (P<0.001 and P=0.032). On multivariable analysis from the model with fully available data (N=216) progression to induction was significantly prognostic for PFS and OS (P=0.003), but prior paclitaxel was not (P=0.674 and P=0.739). These results were confirmed after multiple imputation of missing data. Progression to induction chemotherapy could be demonstrated as an independent prognostic factor, in contrast to prior paclitaxel.
authors.affiliation: Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Necchi
authors.affiliation: Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Miceli
authors.affiliation: Medical Oncology, Azienda Ospedaliera di Busto Arsizio, Busto Arsizio, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Bregni
authors.affiliation: Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Bokemeyer
authors.affiliation: Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: L A
authors.initials: LA
authors.lastname: Berger
authors.affiliation: Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Oechsle
authors.affiliation: UKGM-Marburg Klinik for Hematology and Oncology, Marburg, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Schumacher
authors.affiliation: Imperial College, Hammersmith Hospital, London, UK.
authors.forename: E
authors.initials: E
authors.lastname: Kanfer
authors.affiliation: Gustave Roussy, Institut de cancérologie, Villejuif, France.
authors.forename: J H
authors.initials: JH
authors.lastname: Bourhis
authors.affiliation: Gustave Roussy, Institut de cancérologie, Villejuif, France.
authors.forename: C
authors.initials: C
authors.lastname: Massard
authors.affiliation: European Institute of Oncology, Milano, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Laszlo
authors.affiliation: European Institute of Oncology, Milano, Italy.
authors.forename: J
authors.initials: J
authors.lastname: Montoro
authors.affiliation: Centre Léon Bérard, Lyon, France.
authors.forename: A
authors.initials: A
authors.lastname: Flechon
authors.affiliation: Gulhane Military Medical Academy, Ankara, Turkey.
authors.forename: F
authors.initials: F
authors.lastname: Arpaci
authors.affiliation: Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Secondino
authors.affiliation: Universitätsklinikum Heidelberg, Heidelberg, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Wuchter
authors.affiliation: Universitätsklinikum Heidelberg, Heidelberg, Germany.
authors.forename: P
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authors.lastname: Dreger
authors.affiliation: University Hospital of Aachen, Aachen, Germany.
authors.forename: M
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authors.lastname: Crysandt
authors.affiliation: University of Vienna, Vienna, Austria.
authors.forename: N
authors.initials: N
authors.lastname: Worel
authors.affiliation: Universitätsmedizin, Greifswal, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Kruger
authors.affiliation: Klinikum Karlsruhe gGmbH, Karlsruhe, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Ringhoffer
authors.affiliation: Kapadokya BMT Center, Kayseri, Turkey.
authors.forename: A
authors.initials: A
authors.lastname: Unal
authors.affiliation: Chaim Sheba Medical Center, Tel-Hashomer, Israel.
authors.forename: A
authors.initials: A
authors.lastname: Nagler
authors.affiliation: Instituto Português de Oncologia do Porto, Porto, Portugal.
authors.forename: A
authors.initials: A
authors.lastname: Campos
authors.affiliation: Umea University Hospital, Umeå, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Wahlin
authors.affiliation: Centro di Riferimento Oncologico, Aviano, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Michieli
authors.affiliation: Gazi University of Medicine, Ankara, Turkey.
authors.forename: G
authors.initials: G
authors.lastname: Sucak
authors.affiliation: University Hospital of Careggi, Firenze, Italy.
authors.forename: I
authors.initials: I
authors.lastname: Donnini
authors.affiliation: Universitair Ziekenhuis, Brussel, Belgium.
authors.forename: R
authors.initials: R
authors.lastname: Schots
authors.affiliation: Centre Hospitalier Universitaire (CHU), Angers, France.
authors.forename: N
authors.initials: N
authors.lastname: Ifrah
authors.affiliation: EBMT Study Office, EBMT, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Badoglio
authors.affiliation: Azienda Ospedaliera BMM, Reggio Calabria, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Martino
authors.affiliation: Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Raggi
authors.affiliation: Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Giannatempo
authors.affiliation: Ospedale Ca' Foncello, Treviso, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Rosti
authors.affiliation: Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Pedrazzoli
authors.affiliation: Istituti Ospitalieri di Cremona, Cremona, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Lanza
mesh_terms: D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D060828:Induction Chemotherapy; D008297:Male; D009373:Neoplasms, Germ Cell and Embryonal / Q000401:mortality* / Q000628:therapy*; D017239:Paclitaxel / Q000008:administration & dosage*; D016879:Salvage Therapy; D015996:Survival Rate; D055815:Young Adult
chemical_list: D017239:Paclitaxel