Salvage High-Dose Chemotherapy for Relapsed Pure Seminoma in the Last 10 Years: Results From the European Society for Blood and Marrow Transplantation Series 2002-2012

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• 作者：Andrea Necchi¹ ; ^{andrea.necchi@istitutotumori.mi.it} ; Salvatore Lo Vullo¹ ; Marco Bregni² ; Giovanni Rosti³ ; Luigi Mariani¹ ; Daniele Raggi¹ ; Patrizia Giannatempo¹ ; Simona Secondino³ ; Kathrin Schumacher⁴ ; Christophe Massard⁵ ; Edward Kanfer⁶ ; Karin Oechsle⁷ ; Daniele Laszlo⁸ ; Mariagrazia Michieli⁹ ; Norbert Ifrah¹⁰ ; Melanie Mercier¹⁰ ; Martina Crysandt¹¹ ; Patrick Wuchter¹² ; Arnon Nagler¹³ ; Anders Wahlin¹⁴ ; Massimo Martino¹⁵ ; Manuela Badoglio¹⁶ ; Paolo Pedrazzoli³ ; Francesco Lanza¹⁷ ; on behalf of the European Society for Blood ; Marrow Transplantation (EBMT) Solid Tumors Working Party
• 关键词：High-dose chemotherapy ; Prognostic factors ; Salvage chemotherapy ; Seminoma ; Survival
• 刊名：Clinical Genitourinary Cancer
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：15
• 期：1
• 页码：163-167
• 全文大小：212 K
• 卷排序：15

文摘

The optimal management of advanced seminoma that relapses after chemotherapy remains unknown. We retrospectively analyzed outcomes with the use of high-dose chemotherapy (HDCT).Patients and MethodsEligibility included adult male patients with pure seminomatous histology and treatment with salvage HDCT. Data of patients who received HDCT from 13 European Society for Blood and Marrow Transplantation (EBMT) centers were used. Multivariable Cox analyses evaluated the association of prespecified factors (line of treatment, prior radiotherapy, and chemosensitivity according to standard definition), with progression-free (PFS) and overall survival (OS). The prognostic ability of the model was assessed through the concordance statistic.ResultsFrom December 2002 to December 2012, 46 cases were identified. Median age was 38 years (interquartile range, 35-46 years). HDCT was provided as second-line therapy (n = 14, 30.4%) and in third-line or beyond third-line therapy (n = 20, 43.5%; 12 had missing information). Sixteen patients (34.8%) received paraortic and/or iliac radiotherapy, and 10 (21.7%) had disease that was cisplatin refractory or absolutely refractory. Median follow-up was 22 months (interquartile range, 8-56). On multivariable Cox analysis, refractory disease was a significantly negative prognostic factor for both PFS (hazard ratio, 6.04; 95% confidence interval, 1.86-19.64) and OS (hazard ratio, 3.93; 95% confidence interval, 1.07-14.45), while prior radiotherapy trended to significance for both. The c index was 0.74 and 0.66 for PFS and OS, respectively. The small numbers and the lack of any comparison with conventional-dose chemotherapy are major study limitations.ConclusionDespite our small sample size, this retrospective analysis suggested that HDCT may represent a valuable therapeutic option for patients with a pure seminoma after standard-dose chemotherapy failure. Our observation requires validation through a prospective study.