TY - JOUR
T1 - Autologous Hematopoietic Stem Cell Transplantation for Male Germ Cell Tumors
T2 - Improved Outcomes Over 3 Decades
AU - Kilari, Deepak
AU - D'Souza, Anita
AU - Fraser, Raphael
AU - Qayed, Muna
AU - Davila, Omar
AU - Agrawal, Vaibhav
AU - Diaz, Miguel Angel
AU - Chhabra, Saurabh
AU - Cerny, Jan
AU - Copelan, Edward
AU - Farhadfar, Nosha
AU - Freytes, Cesar O.
AU - Gale, Robert Peter
AU - Ganguly, Siddhartha
AU - Hildebrandt, Gerhard C.
AU - Holmberg, Leona
AU - Kamble, Rammurti T.
AU - Kapoor, Prashant
AU - Lazarus, Hillard
AU - Lee, Cindy
AU - Murthy, Hemant S.
AU - Naik, Seema
AU - Nishihori, Taiga
AU - Saad, Ayman
AU - Savani, Bipin N.
AU - Seo, Sachiko
AU - Warwick, Anne
AU - Wirk, Baldeep
AU - Yared, Jean A.
AU - Nieto, Yago
AU - Hari, Parameswaran
N1 - Publisher Copyright:
© 2019
PY - 2019/6
Y1 - 2019/6
N2 - 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.
AB - 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.
KW - Autologous
KW - Germ cell cancers
KW - Transplantation
UR - http://www.scopus.com/inward/record.url?scp=85064954131&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85064954131&partnerID=8YFLogxK
U2 - 10.1016/j.bbmt.2019.02.015
DO - 10.1016/j.bbmt.2019.02.015
M3 - Article
C2 - 30794931
AN - SCOPUS:85064954131
SN - 1083-8791
VL - 25
SP - 1099
EP - 1106
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
IS - 6
ER -