High-dose chemotherapy and autologous hematopoietic stem cell transplantation (HCAT) in the treatment of germ cell tumors: Retrospective analysis of The National Cancer Institute-Brasil

Abstract

4791 Background: HCAT can be used as salvage therapy in relapsed or refractory germ cell tumors (GCT). The success rates of HCAT vary according to the timing of its indication and the presence of bad prognostic variables: cisplatin-refractory disease, progressive disease before HCAT, beta-HCG greater than 1,000 U/l and mediastinal primary. This study describes the prognostic features, progression-free survival (PFS) and overall survival (OS) of all transplanted patients (pts) with GCT treated at our institution. Methods: Retrospective chart review from 1996 to 2003. Eleven pts underwent HCAT with conventional carboplatin/ etoposide for intermediate or poor risk GCT. One pt was not available for follow-up. Results: Median pts age at diagnosis was 21.5 years (range 16–40). Nine patients had non-seminomatous GCT and 1 had pure seminoma. All patients received initial cisplatin-based chemotherapy (BEP in 8 pts) and 4 underwent surgery for residual disease with negative markers. After initial treatment, 2 pts had partial response but positive markers; one of them underwent HCAT as primary rescue. Chemotherapy regimen at relapse (8 pts) or persistent disease (1 pt) consisted of VIP /VeIP. Of these pts, 4 underwent HCAT after second remission, 1 as rescue after second relapse and 4 after third relapse. At HCAT, 5 pts had none of the bad prognostic variables, 3 pts had 1 and 2 pts had 2. No pt had cisplatin-refractory disease or mediastinal primary tumor. Deaths did not occurred in the early post-transplant period. Until December 2004, 9 pts had disease progression, 8 of them died and 1 is alive on treatment. Median PFS after HCAT was 5 months (range 1 - 74) and median OS 13.5 months (4 - 74). Only 1 pt is alive and without evidence of disease after 5 years (seminoma). Conclusions: HCAT for relapsed or refractory GCT was not frequently tested and indicated as a late treatment option in our institution. Toxicity of HCAT did not compromise survival. Despite the good or intermediate prognostic score, only 1 out of 10 pts was cured. No significant financial relationships to disclose.