High-dose chemotherapy with autologous stem-cell transplantation for relapsed metastatic germ cell tumors The Alberta experience

• Published in: Canadian Urological Association journal 2024-03, Vol.18 (3), p.E73-E79
• Main Authors: Zhang, Hanbo, Alimohamed, Nimira S, Basappa, Naveen S, Cheng, Tina, Chu, Michael, Cox-Kennett, Nanette, Ernst, D Scott, Fontaine, Amelie, Ghosh, Sunita, Heng, Daniel Y C, Littleton, Richard, North, Scott, Railton, Cindy, Sandhu, Irwindeep, Stenson, Trevor H, Stewart, Douglas A, Venner, Christopher P, Venner, Peter, Kolinsky, Michael P
• Format: Article
• Language: English
• Subjects: Cancer; Care and treatment; Chemotherapy; Development and progression; Diagnosis; Diseases; Germ cell tumors; Medical research; Medicine, Experimental; Metastasis; Original Research; Patient outcomes; Pharmaceutical industry; Relapse; Stem cells; Transplantation
• ISSN: 1911-6470; 1920-1214
• DOI: 10.5489/cuaj.8493

High-dose chemotherapy with autologous stem-cell transplantation (HDC-ASCT) is standard therapy for metastatic germ cell tumors (mGCTs) in patients whose disease progresses during or after conventional chemotherapy. We conducted a retrospective review of HDC-ASCT in relapsed mGCT patients in the province of Alberta, Canada, over the past two decades. Patients with mGCTs who received HDC-ASCT at two provincial cancer referral centers from 2000-2018 were identified from institutional databases. Baseline clinical and treatment characteristics were collected, as well as overall survival (OS ) and disease-free survival (DFS). Relevant prognostic variables were analyzed. Forty-three patients were identified. The median age was 28 years (range 19-56). A majority (95%) had non-seminoma histology and testis/retroperitoneal primary (84%). Twenty patients (47%) had poor-risk disease, as per The International Germ Cell Consensus Classification (IGCCC), at start of first-line chemotherapy. HDC-ASCT was used as second-line therapy in 65% of patients, and 58% of ASCT patients received tandem transplants. Median followup after ASCT was 22 months (range 2-181). At last followup, 42% of patients were alive without disease, including 3/7 (43%) of patients with primary mediastinal disease. Two-year and five-year DFS/OS ratios were 44%/65% and 38%/45%, respectively. Median OS and DFS for all patients were 30.0 months (13.3-46.6) and 8.0 months (0.9-15.1), respectively. We found that HDC-ASCT is an effective salvage therapy in mGCT, consistent with existing literature. Patients appeared to benefit regardless of primary site. Although limited by small sample size, we found a numerical difference in DFS and OS between second- and third-line HDC-ASCT and single vs. tandem ASCT.