Autologous Hematopoietic Stem Cell Transplantation for Male Germ Cell Tumors: Improved Outcomes Over 3 Decades

Deepak Kilari, Anita D'Souza, Raphael Fraser, Muna Qayed, Omar Davila, Vaibhav Agrawal, Miguel Angel Diaz, Saurabh Chhabra, Jan Cerny, Edward Copelan, Nosha Farhadfar, Cesar O. Freytes, Robert Peter Gale, Siddhartha Ganguly, Gerhard C. Hildebrandt, Leona Holmberg, Rammurti T. Kamble, Prashant Kapoor, Hillard Lazarus, Cindy LeeHemant S. Murthy, Seema Naik, Taiga Nishihori, Ayman Saad, Bipin N. Savani, Sachiko Seo, Anne Warwick, Baldeep Wirk, Jean A. Yared, Yago Nieto, Parameswaran Hari

Research output: Contribution to journalArticle

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Abstract

The curative potential of autologous hematopoietic cell transplantation (autoHCT) for male germ cell tumors (GCTs) is well established. The optimal timing and number (single transplant [ST] versus tandem transplants [TT] versus triple transplants) of autoHCT are controversial, with wide practice variations. We examined survival trends among 2395 recipients of autoHCT for male GCTs between 1990 and 2015 reported to the Center for International Blood and Marrow Transplant Research. Trends and outcomes were analyzed by year of transplantation for intervals 1990 to 1994 (N = 288), 1995 to 1999 (N = 351), 2000 to 2004 (N = 376), 2005 to 2009 (N = 509), and 2010 to 2015 (N = 871). Multivariate analysis was restricted to the subset from 2000 to 2015 with research-level data (n = 267). The median duration of follow-up was 51 months. The median age at autoHCT was 31 years; 633 patients (26%) had primary extragonadal GCT, and 1167 (49%) underwent TT. The 3-year progression-free (PFS) and overall survival (OS) improved from 24% (95% confidence interval [CI], 18% to 31%) and 35% (95% CI, 29% to 40%), respectively, in 1990 to 1994 to 47% (95% CI, 43% to 50%) and 54% (95% CI, 50% to 57%), respectively, in 2010 to 2015 (P < .0001). TT recipients were more likely than ST recipients to undergo autoHCT as first salvage treatment. The proportion of TTs increased from 38% of all autoHCTs in 2000 to 2004 to 77% in 2010 to 2015. Nonseminoma histology, residual disease at autoHCT, >1 line of pretransplantation chemotherapy, and ST versus TT were associated with inferior PFS and OS. Post-transplantation survival has improved significantly over time for relapsed/refractory male GCT and is associated with the increased use of TTs (compared with STs) and performance of autoHCT earlier in the disease course.

Original languageEnglish (US)
Pages (from-to)1099-1106
Number of pages8
JournalBiology of Blood and Marrow Transplantation
Volume25
Issue number6
DOIs
StatePublished - Jun 2019

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Keywords

  • Autologous
  • Germ cell cancers
  • Transplantation

ASJC Scopus subject areas

  • Hematology
  • Transplantation

Cite this

Kilari, D., D'Souza, A., Fraser, R., Qayed, M., Davila, O., Agrawal, V., Diaz, M. A., Chhabra, S., Cerny, J., Copelan, E., Farhadfar, N., Freytes, C. O., Gale, R. P., Ganguly, S., Hildebrandt, G. C., Holmberg, L., Kamble, R. T., Kapoor, P., Lazarus, H., ... Hari, P. (2019). Autologous Hematopoietic Stem Cell Transplantation for Male Germ Cell Tumors: Improved Outcomes Over 3 Decades. Biology of Blood and Marrow Transplantation, 25(6), 1099-1106. https://doi.org/10.1016/j.bbmt.2019.02.015