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Biol Blood Marrow Transplant. 2019 Feb 20. pii: S1083-8791(19)30140-5. doi: 10.1016/j.bbmt.2019.02.015. [Epub ahead of print]

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

Author information

1
Medical College of Wisconsin, Milwaukee, Wisconsin. Electronic address: dkilari@mcw.edu.
2
Center for International Blood and Marrow Transplantation, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
3
Center for International Blood and Marrow Transplantation, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin.
4
Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.
5
Indiana University Simon Cancer Center, Indianapolis, Indiana.
6
Department of Hematology/Oncology, Hospital Infantil Universitario Nino Jesus, Madrid, Spain.
7
Medical College of Wisconsin, Milwaukee, Wisconsin.
8
UMass Memorial Medical Center, Worcester, Massachusetts.
9
Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, North Carolina.
10
University of Florida, Gainesville, Florida.
11
Texas Transplant Institute, San Antonio, Texas.
12
Hematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, United Kingdom.
13
Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, Kansas.
14
Markey Cancer Center, University of Kentucky, Lexington, Kentucky.
15
Fred Hutchinson Cancer Research Center, Seattle, Washington.
16
Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, Texas.
17
Mayo Clinic Rochester, Rochester, Minnesota.
18
Seidman Cancer Center, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio.
19
Royal Adelaide Hospita, Adelaide, South Australia, Australia.
20
Penn State Hershey Medical Center, Hershey, Pennsylvania.
21
Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
22
Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
23
Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
24
Department of Hematology and Oncology, National Cancer Research Center East, Chiba, Japan.
25
Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
26
Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, Washington.
27
Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, Maryland.
28
Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas M.D. Anderson Cancer Center, Houston, Texas.

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.

KEYWORDS:

Autologous; Germ cell cancers; Transplantation

PMID:
30794931
DOI:
10.1016/j.bbmt.2019.02.015

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