High-dose chemotherapy with autologous peripheral blood stem cell transplantation in patients with poor- and intermediate-prognosis metastatic germ cell tumors: A retrospective monocenter analysis of 44 cases.

Abstract

e15043 Background: Metastatic germ cell tumors (GCT) are curable. The International Germ Cell Cancer Collaborative Group (IGCCCG) reports a poor prognosis subgroup with a 5-year survival rate of 48%. High-dose chemotherapy with autologous peripheral blood stem cell transplantation (HD-PBSCT) in these patients showed promising results in phase II trials, but failed to show significant advantage in randomized trials. We report on our series of patients with poor and intermediate prognosis GCT treated with individually tailored multiple-course HD-PBSCT and secondary surgery of remaining tissue. Methods: We performed a retrospective analysis of our complete single center series of 44 patients (40 poor prognosis; 4 intermediate prognosis) treated with HD-PBSCT. All patients received 1 up to 6 cycles of standard-dose cisplatin-etoposide-ifosfamide (PEI) chemotherapy followed by granulocyte colony-stimulating factor and stem cell mobilisation. Subsequent high-dose chemotherapy regimen HD-PEI was adapted from a phase I/II trial of the German Testicular Cancer Study Group (GTCSG). In 14 patients we added paclitaxel according to another phase I/II study by the GTCSG. Up to 4 cycles of HD-chemotherapy were administered according to individual patient’s response and tolerability. Patients with residual disease in computed tomography (CT) or positron-emission tomography (PET)-CT underwent secondary surgery. Results: In this retrospective analysis the CR rate after up to 4 cycles of HD-PBSCT and resection was 73%. Three patients showing a marker-negative PR did not undergo surgery, because they were PET negative and/or fine needle aspiration did not show viable tumor. The 3-year survival rate was 80%, with a median follow up of 43 months (range: 3-130 months). Disease-related death rate was 16%. Treatment-related death after HD-PBSCT did not occur. One patient died postoperatively. Conclusions: In our single center experience multiple courses of individually tailored HD-PBSCT is a safe and effective treatment option in poor and intermediate prognosis metastatic germ cell cancer.