Survival Outcomes After High-dose Chemotherapy and Stem Cell Transplantation in the Salvage Setting for Relapsed or Refractory Germ Cell Cancers

Abstract

Background/Aim: High-dose chemotherapy (HDCT) and stem cell transplantation (SCT) have been established as the standard of care in patients with relapsed germ cell tumours (GCTs). We evaluated the safety, efficacy and tolerability of HDCT/ SCT in patients with relapsed GCTs. Patients and Methods: Twenty-eight patients with relapsed GCTs, treated with HDCT, were included in this study. The conditioning regime was carboplatin, etoposide, cyclophosphamide and paclitaxel. Clinical, radiological imaging and tumour markers determined treatment outcomes. Results: Median age was 35 years (range=21-57 years) with 26 males and 2 females. Median time to first relapse was 6 months. Median time to progression after 2 nd line chemotherapy was 17.3 months. Fourteen patients hadMedian survival was 62 months and 16 patients (57%) are in clinical follow-up with surveillance. Conclusion: In relapsed GCT patients, median survival may exceed 5 years post-HDCT and SCT.

High-Dose Chemotherapy and Autologous Stem Cell Transplantation for Salvage Therapy of Relapsed/Refractory Germ Cell Tumors: A Single-Center Experience

“…In our study, the median PFS was 25.8 months. These results were consistent with survival outcomes reported in the literature [6,12].…”

“…Although the prognosis for patients with intermediate risk is excellent, the treatment of patients with poor prognosis needs to be improved. The standard of care for newly diagnosed advanced germ cell tumors is the bleomycin-etoposide-cisplatin combination (BEP) regimen [6]. Despite high cure rates, 20–30% of patients have refractory disease after first-line therapy or relapse during follow-up [7].…”

“…Considering the rarity of this type of cancer and the low rates of recurrence/resistant disease, the results of subsequent treatment steps are limited by the small number of patients. Due to the retrospective nature of the data, comparison between treatment strategies is difficult, and therefore, extrapolation is even more limited [6]. Clinicians usually make their decisions based on the results of non-randomized studies, the experience of the center, and the prognostic factors of the patient; HDCT and ASCT are generally preferred for cases with poor prognostic factors.…”

Therapeutic efficacy of high-dose chemotherapy with autologous stem-cell transplantation in 44 relapsed or refractory germ-cell tumor patients: A retrospective cohort study

“…The median age range and IGCCCG risk group distribution of our patients are comparable with other studies. [13,14,17,18] In this regard, our results are comparable with clinical studies evaluating the efficacy of HDCT. Therefore, we believe the best response to HDCT and the primary tumor site is important when estimating our cohort PFS and OS.…”

“…Nonetheless, we found that carbo-PEC-taxol outperformed other regimens regarding PFS, including the CE regimen. In a retrospective study of 28 patients with relapsed/refractory GCT, Sharma et al [18] evaluated the survival outcomes of patients who received carbo-PEC-taxol HDCT regimen as an initial salvage therapy. In this study, the median PFS was 17.3 months following a median follow-up period of 5 years.…”