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Autologous Transplantation for Male Germ Cell Tumors: Improved Outcomes over 3 decades
Kilari, D., D'Souza, A., Fraser, R., Qayed, M., Davila, O., Agrawal, V., Diaz, M. A., Chhabra, S., Cerny, J., Copelan, E., et al
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation. 2019
Abstract
PURPOSE The curative potential of autologous hematopoietic cell transplantation (autoHCT) for male germ cell tumors (GCT) is well established. Optimal timing and number (single, ST vs. tandem, TT vs. three) of autoHCT are controversial with wide practice variation. PATIENTS AND METHODS We examined survival trends among 2,395 recipients of autoHCT for male GCT between 1990-2015 reported to the Center for International Blood and Marrow Transplant Research. Trends and outcomes were analyzed by year of transplant for intervals 1990-94 (N=288), 1995-99 (N=351), 2000-04 (N=376), 2005-09 (N=509) and 2010-15 (N=871). Multivariate analysis was restricted to the subset from 2000-2015 (n=267) with research level data. RESULTS Median follow up was 51 months. Median age at autoHCT was 31 years; 633(26%) had primary extragonadal GCT and 1,167 (49%) underwent TT. The 3-year progression-free (PFS) and overall survival (OS) improved from 24 (18-31)% and 35 (29-40)% in 1990-94 to 47 (43-50)% and 54 (50-57)% in 2010-15 (p < 0.0001), respectively. TT recipients were more likely to undergo autoHCT as first salvage treatment than ST recipients. The proportion of TT increased from 38% of all autoHCT in 2000-04 to 77% in 2010-15. Non-seminoma histology, residual disease at autoHCT, > 1 line of pre-transplant chemotherapy and ST versus TT were associated with inferior PFS and OS. CONCLUSIONS Post-transplant survival has improved significantly over time for relapsed/refractory male GCT and was associated with the increased use of TT (compared with ST) and earlier autoHCT in the disease course.