High-dose chemotherapy as salvage treatment in germ cell tumors: a multivariate analysis of prognostic variables.

Abstract

Prognostic variables for treatment response after HDCT can be identified. The proposed prognostic model might help to optimize the use of HDCT in germ cell tumors and warrants validation in future trials.

Long-term results of autologous marrow transplantation for relapsed or refractory male or female germ cell tumors

“…One patient underwent a second autologous transplant using a carboplatin/etoposide-conditioning regimen for persistent viable carcinoma (at post-transplant surgery) following his first transplant 2 months earlier. The mean doses of agents used were similar to doses reported by other transplant centers 10 (carboplatin mean dose 1973 mg/m 2 ; etoposide mean dose 1860 mg/m 2 ; cyclophosphamide 120 mg/kg). All evaluable patients engrafted within the usual range for autologous bone marrow as the source of stem cells (see Table 2).…”

“…[4][5][6][7][8][9] Recently, data on 283 heavCorrespondence: RA Mandanas, 920 SL Young Blvd WP2010, Oklahoma City, OK 73104, USA Received 23 June 1997; accepted 2 October 1997 ily pretreated patients with disseminated germ cell tumors from four large centers in the USA and Europe have been analyzed retrospectively for prognostic variables that predict a poor outcome with high-dose chemotherapy and hematopoietic stem cell support. 10 The resulting model categorized patients into three groups based on the number of prognostic factors present and allows the separation of poor (3-5 risk factors) risk patients from good (0 risk factors) and intermediate (1 or 2 risk factors) risk patients who might still have a beneficial outcome (27-51% 2-year failure-free survival) following high-dose chemotherapy and autologous stem cell support. Female patients with ovarian germ cell neoplasms were excluded from this analysis and although published data on high-dose chemotherapy with stem cell support for ovarian germ cell tumors is relatively scarce, there are reports 6 that suggest the utility of this approach in this population with germ cell malignancies as well.…”

“…Our numbers are too small to perform multivariate analyses of different prognostic factors or an analysis of univariate factors for subgroups. A collaborative effort from four larger centers in Europe and the USA, 10 however, has generated a prognostic model based on five pre-transplant prognostic factors that can predict outcome following transplantation for relapsed and refractory germ cell tumors in males. The five factors included progressive disease before HDC, mediastinal primary tumor, refractory disease before HDC, absolute refractory disease, and beta-HCG Ͼ1000 U/l before HDC.…”

“…11 Tumor markers represented either beta-HCG or alpha fetoprotein or both. For response cri-teria, the definitions used by Beyer et al 10 were used: clinical complete remission (cCR), total radiographic disappearance of measurable tumor and normalization of tumor markers with chemotherapy alone; pathologic complete remission (pCR), complete resection of no viable malignancy (necrosis or fibrosis) or mature teratoma without any evidence of residual tumor; surgical complete remission (sCR), complete resection of viable malignancy or immature teratoma without any evidence of residual tumor; marker-negative partial remission (PRm−), greater than 50% reduction of radiologically measurable disease with normal tumor markers; marker-positive partial remission (PRm+) greater than 50% reduction of radiologically measurable disease with elevated tumor markers, or greater than 90% reduction of elevated tumor markers; progressive disease (PD), an increase of any radiologically measurable tumor by greater than 25% or a greater than 10% increase of elevated tumor markers; stable disease (SD), represented a response that did not qualify as either PRm− or PRm+ or a PD. Response assessments were performed 4-6 weeks after the transplant date.…”

“…10 The resulting model categorized patients into three groups based on the number of prognostic factors present and allows the separation of poor (3-5 risk factors) risk patients from good (0 risk factors) and intermediate (1 or 2 risk factors) risk patients who might still have a beneficial outcome (27-51% 2-year failure-free survival) following high-dose chemotherapy and autologous stem cell support. Female patients with ovarian germ cell neoplasms were excluded from this analysis and although published data on high-dose chemotherapy with stem cell support for ovarian germ cell tumors is relatively scarce, there are reports 6 that suggest the utility of this approach in this population with germ cell malignancies as well.…”