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

The Alberta experience

Authors

  • Hanbo Zhang University of Manitoba
  • Nimira S. Alimohamed University of Calgary
  • Naveen S. Basappa University of Alberta
  • Tina Cheng University of Calgary
  • Michael Chu University of Alberta
  • Nanette Cox-Kennett University of Alberta
  • D. Scott Ernst Western University
  • Amelie Fontaine University of Alberta
  • Sunita Ghosh University of Alberta
  • Daniel Y.C. Heng University of Calgary
  • Richard Littleton University of Alberta
  • Scott North University of Alberta
  • Cindy Railton Tom Baker Cancer Centre, Calgary
  • Irwindeep Sandhu University of Alberta
  • Trevor H. Stenson Cross Cancer Institute, Edmonton
  • Douglas A. Stewart University of Calgary
  • Christopher P. Venner
  • Peter Venner BC Cancer Vancouver Centre
  • Michael P. Kolinsky University of Alberta

DOI:

https://doi.org/10.5489/cuaj.8493

Keywords:

Testicular cancer, Germ cell tumors, autologous stem cell transplantation, real world outcomes

Abstract

INTRODUCTION: 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.

METHODS: 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.

RESULTS: 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 secondline 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.

CONCLUSIONS: 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.

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Published

2023-11-20

How to Cite

Zhang, H. ., Alimohamed, N. S., Basappa, N. S., Cheng, T., Chu, M., Cox-Kennett, N., Ernst, D. S., Fontaine, A., Ghosh, S., Heng, D. Y., Littleton, R., North, S., Railton, C., Sandhu, I., Stenson, T. H., Stewart, D. A., Venner, C. P., Venner, P. ., & Kolinsky, M. P. (2023). High-dose chemotherapy with autologous stem-cell transplantation for relapsed metastatic germ cell tumors: The Alberta experience. Canadian Urological Association Journal, 18(3), E73–9. https://doi.org/10.5489/cuaj.8493

Issue

Vol. 18 No. 3 (2024): CUAJ March

Section

Original Research

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