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 journalArticlepeer-review

4 Scopus citations

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

Bibliographical note

Funding Information:
The CIBMTR is supported primarily by Public Health Service Grant/Cooperative Agreement 5U24CA076518 from the National Cancer Institute (NCI), the National Heart, Lung and Blood Institute (NHLBI), and the National Institute of Allergy and Infectious Diseases; Grant/Cooperative Agreement 4U10HL069294 from the NHLBI and NCI; Contract HHSH25020170006C with the Health Resources and Services Administration; Grants N00014-17-1-2388 and N0014-17-1-2850 from the Office of Naval Research; and grants from *Actinium Pharmaceuticals, *Amgen, *Amneal Biosciences; *Angiocrine Bioscience, anonymous donation to the Medical College of Wisconsin, Astellas Pharma US, Atara Biotherapeutics, Be the Match Foundation, *bluebird bio, *Bristol Myers Squibb Oncology, *Celgene, Cerus, *Chimerix, Fred Hutchinson Cancer Research Center, Gamida Cell, Gilead Sciences, HistoGenetics, Immucor, *Incyte, Janssen Scientific Affairs, *Jazz Pharmaceuticals, Juno Therapeutics, Karyopharm Therapeutics, Kite Pharma, Medac, MedImmune, The Medical College of Wisconsin, *Mediware, *Merck & Co, *Mesoblast, MesoScale Diagnostics, Millennium, the Takeda Oncology Co, *Miltenyi Biotec, National Marrow Donor Program, *Neovii Biotech NA, Novartis Pharmaceuticals, Otsuka Pharmaceutical, PCORI, *Pfizer, *Pharmacyclics, PIRCHE, *Sanofi Genzyme, *Seattle Genetics, Shire, Spectrum Pharmaceuticals, St. Baldrick's Foundation, *Sunesis Pharmaceuticals, Swedish Orphan Biovitrum, Takeda Oncology, Telomere Diagnostics, and the University of Minnesota. The views expressed in this article do not reflect the official policy or position of the National Institutes of Health, the Department of the Navy, the Department of Defense, the Health Resources and Services Administration, or any other agency of the US Government. *Corporate member. Conflicts of Interest statement: There are no conflicts of interest to report. Financial disclosure: See Acknowledgments on page 1105.

Funding Information:
The CIBMTR is supported primarily by Public Health Service Grant/Cooperative Agreement 5U24CA076518 from the National Cancer Institute (NCI), the National Heart, Lung and Blood Institute (NHLBI), and the National Institute of Allergy and Infectious Diseases ; Grant/Cooperative Agreement 4U10HL069294 from the NHLBI and NCI; Contract HHSH25020170006C with the Health Resources and Services Administration; Grants N00014-17-1-2388 and N0014-17-1-2850 from the Office of Naval Research ; and grants from *Actinium Pharmaceuticals, *Amgen, *Amneal Biosciences; *Angiocrine Bioscience, anonymous donation to the Medical College of Wisconsin, Astellas Pharma US, Atara Biotherapeutics, Be the Match Foundation, *bluebird bio, *Bristol Myers Squibb Oncology, *Celgene, Cerus, *Chimerix, Fred Hutchinson Cancer Research Center, Gamida Cell, Gilead Sciences, HistoGenetics, Immucor, *Incyte, Janssen Scientific Affairs, *Jazz Pharmaceuticals, Juno Therapeutics, Karyopharm Therapeutics, Kite Pharma, Medac, MedImmune, The Medical College of Wisconsin, *Mediware, *Merck & Co, *Mesoblast, MesoScale Diagnostics, Millennium, the Takeda Oncology Co, *Miltenyi Biotec, National Marrow Donor Program, *Neovii Biotech NA, Novartis Pharmaceuticals, Otsuka Pharmaceutical, PCORI, *Pfizer, *Pharmacyclics, PIRCHE, *Sanofi Genzyme, *Seattle Genetics, Shire, Spectrum Pharmaceuticals, St. Baldrick's Foundation, *Sunesis Pharmaceuticals, Swedish Orphan Biovitrum, Takeda Oncology, Telomere Diagnostics, and the University of Minnesota. The views expressed in this article do not reflect the official policy or position of the National Institutes of Health, the Department of the Navy, the Department of Defense, the Health Resources and Services Administration, or any other agency of the US Government.

Publisher Copyright:
© 2019

Keywords

  • Autologous
  • Germ cell cancers
  • Transplantation

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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