title: Salvage High-Dose Chemotherapy for Relapsed Pure Seminoma in the Last 10 Years: Results From the European Society for Blood and Marrow Transplantation Series 2002-2012.
abstract: The optimal management of advanced seminoma that relapses after chemotherapy remains unknown. We retrospectively analyzed outcomes with the use of high-dose chemotherapy (HDCT).
  
  
  
  Eligibility included adult male patients with pure seminomatous histology and treatment with salvage HDCT. Data of patients who received HDCT from 13 European Society for Blood and Marrow Transplantation (EBMT) centers were used. Multivariable Cox analyses evaluated the association of prespecified factors (line of treatment, prior radiotherapy, and chemosensitivity according to standard definition), with progression-free (PFS) and overall survival (OS). The prognostic ability of the model was assessed through the concordance statistic.
  
  
  
  From December 2002 to December 2012, 46 cases were identified. Median age was 38 years (interquartile range, 35-46 years). HDCT was provided as second-line therapy (n = 14, 30.4%) and in third-line or beyond third-line therapy (n = 20, 43.5%; 12 had missing information). Sixteen patients (34.8%) received paraortic and/or iliac radiotherapy, and 10 (21.7%) had disease that was cisplatin refractory or absolutely refractory. Median follow-up was 22 months (interquartile range, 8-56). On multivariable Cox analysis, refractory disease was a significantly negative prognostic factor for both PFS (hazard ratio, 6.04; 95% confidence interval, 1.86-19.64) and OS (hazard ratio, 3.93; 95% confidence interval, 1.07-14.45), while prior radiotherapy trended to significance for both. The c index was 0.74 and 0.66 for PFS and OS, respectively. The small numbers and the lack of any comparison with conventional-dose chemotherapy are major study limitations.
  
  
  
  Despite our small sample size, this retrospective analysis suggested that HDCT may represent a valuable therapeutic option for patients with a pure seminoma after standard-dose chemotherapy failure. Our observation requires validation through a prospective study.
authors.affiliation: Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy. Electronic address: andrea.necchi@istitutotumori.mi.it.
authors.forename: Andrea
authors.initials: A
authors.lastname: Necchi
authors.affiliation: Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Lo Vullo
authors.affiliation: Medical Oncology, Azienda Ospedaliera di Busto Arsizio, Busto Arsizio, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Bregni
authors.affiliation: Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Rosti
authors.affiliation: Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Mariani
authors.affiliation: Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Raggi
authors.affiliation: Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Giannatempo
authors.affiliation: Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Secondino
authors.affiliation: UKGM-Marburg Klinik for Hematology and Oncology, Marburg, Germany.
authors.forename: Kathrin
authors.initials: K
authors.lastname: Schumacher
authors.affiliation: Gustave Roussy, Institut de cancérologie, Villejuif, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Massard
authors.affiliation: Imperial College, Hammersmith Hospital, London, United Kingdom.
authors.forename: Edward
authors.initials: E
authors.lastname: Kanfer
authors.affiliation: Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Karin
authors.initials: K
authors.lastname: Oechsle
authors.affiliation: European Institute of Oncology, Milano, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Laszlo
authors.affiliation: Centro di Riferimento Oncologico, Aviano, Italy.
authors.forename: Mariagrazia
authors.initials: M
authors.lastname: Michieli
authors.affiliation: Centre Hospitalier Universitaire (CHU), Angers, France.
authors.forename: Norbert
authors.initials: N
authors.lastname: Ifrah
authors.affiliation: Centre Hospitalier Universitaire (CHU), Angers, France.
authors.forename: Melanie
authors.initials: M
authors.lastname: Mercier
authors.affiliation: University Hospital of Aachen, Aachen, Germany.
authors.forename: Martina
authors.initials: M
authors.lastname: Crysandt
authors.affiliation: Universitätsklinikum Heidelberg, Heidelberg, Germany.
authors.forename: Patrick
authors.initials: P
authors.lastname: Wuchter
authors.affiliation: Chaim Sheba Medical Center, Tel-Hashomer, Israel.
authors.forename: Arnon
authors.initials: A
authors.lastname: Nagler
authors.affiliation: Umeå University Hospital, Umeå, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Wahlin
authors.affiliation: Azienda Ospedaliera BMM, Reggio Calabria, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Martino
authors.affiliation: EBMT Study Office, EBMT, Paris, France.
authors.forename: Manuela
authors.initials: M
authors.lastname: Badoglio
authors.affiliation: Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Pedrazzoli
authors.affiliation: Istituti Ospitalieri di Cremona, Cremona, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Lanza
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D016190:Carboplatin / Q000008:administration & dosage* / Q000627:therapeutic use; D018572:Disease-Free Survival; D005047:Etoposide / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D018239:Seminoma / Q000188:drug therapy*; D016019:Survival Analysis; D013736:Testicular Neoplasms / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D005047:Etoposide; D016190:Carboplatin
keywords: High-dose chemotherapy; Prognostic factors; Salvage chemotherapy; Seminoma; Survival