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 journalArticle

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 (US)
Pages (from-to)1099-1106
Number of pages8
JournalBiology of Blood and Marrow Transplantation
Volume25
Issue number6
DOIs
StatePublished - Jun 1 2019

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Hematopoietic Stem Cell Transplantation
Cell Transplantation
Transplants
Confidence Intervals
Survival
Transplantation
Germ Cell and Embryonal Neoplasms
Autografts
Research
Male Germ Cell Tumor
Multivariate Analysis
Bone Marrow
Drug Therapy

All Science Journal Classification (ASJC) codes

  • Hematology
  • Transplantation

Cite this

Kilari, Deepak ; D'Souza, Anita ; Fraser, Raphael ; Qayed, Muna ; Davila, Omar ; Agrawal, Vaibhav ; Diaz, Miguel Angel ; Chhabra, Saurabh ; Cerny, Jan ; Copelan, Edward ; Farhadfar, Nosha ; Freytes, Cesar O. ; Gale, Robert Peter ; Ganguly, Siddhartha ; Hildebrandt, Gerhard C. ; Holmberg, Leona ; Kamble, Rammurti T. ; Kapoor, Prashant ; Lazarus, Hillard ; Lee, Cindy ; Murthy, Hemant S. ; Naik, Seema ; Nishihori, Taiga ; Saad, Ayman ; Savani, Bipin N. ; Seo, Sachiko ; Warwick, Anne ; Wirk, Baldeep ; Yared, Jean A. ; Nieto, Yago ; Hari, Parameswaran. / Autologous Hematopoietic Stem Cell Transplantation for Male Germ Cell Tumors : Improved Outcomes Over 3 Decades. In: Biology of Blood and Marrow Transplantation. 2019 ; Vol. 25, No. 6. pp. 1099-1106.
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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.",
author = "Deepak Kilari and Anita D'Souza and Raphael Fraser and Muna Qayed and Omar Davila and Vaibhav Agrawal and Diaz, {Miguel Angel} and Saurabh Chhabra and Jan Cerny and Edward Copelan and Nosha Farhadfar and Freytes, {Cesar O.} and Gale, {Robert Peter} and Siddhartha Ganguly and Hildebrandt, {Gerhard C.} and Leona Holmberg and Kamble, {Rammurti T.} and Prashant Kapoor and Hillard Lazarus and Cindy Lee and Murthy, {Hemant S.} and Seema Naik and Taiga Nishihori and Ayman Saad and Savani, {Bipin N.} and Sachiko Seo and Anne Warwick and Baldeep Wirk and Yared, {Jean A.} and Yago Nieto and Parameswaran Hari",
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Kilari, D, D'Souza, A, Fraser, R, Qayed, M, Davila, O, Agrawal, V, Diaz, MA, Chhabra, S, Cerny, J, Copelan, E, Farhadfar, N, Freytes, CO, Gale, RP, Ganguly, S, Hildebrandt, GC, Holmberg, L, Kamble, RT, Kapoor, P, Lazarus, H, Lee, C, Murthy, HS, Naik, S, Nishihori, T, Saad, A, Savani, BN, Seo, S, Warwick, A, Wirk, B, Yared, JA, Nieto, Y & Hari, P 2019, 'Autologous Hematopoietic Stem Cell Transplantation for Male Germ Cell Tumors: Improved Outcomes Over 3 Decades', Biology of Blood and Marrow Transplantation, vol. 25, no. 6, pp. 1099-1106. https://doi.org/10.1016/j.bbmt.2019.02.015

Autologous Hematopoietic Stem Cell Transplantation for Male Germ Cell Tumors : Improved Outcomes Over 3 Decades. / Kilari, Deepak; D'Souza, Anita; Fraser, Raphael; Qayed, Muna; Davila, Omar; Agrawal, Vaibhav; Diaz, Miguel Angel; Chhabra, Saurabh; Cerny, Jan; Copelan, Edward; Farhadfar, Nosha; Freytes, Cesar O.; Gale, Robert Peter; Ganguly, Siddhartha; Hildebrandt, Gerhard C.; Holmberg, Leona; Kamble, Rammurti T.; Kapoor, Prashant; Lazarus, Hillard; Lee, Cindy; Murthy, Hemant S.; Naik, Seema; Nishihori, Taiga; Saad, Ayman; Savani, Bipin N.; Seo, Sachiko; Warwick, Anne; Wirk, Baldeep; Yared, Jean A.; Nieto, Yago; Hari, Parameswaran.

In: Biology of Blood and Marrow Transplantation, Vol. 25, No. 6, 01.06.2019, p. 1099-1106.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Autologous Hematopoietic Stem Cell Transplantation for Male Germ Cell Tumors

T2 - Improved Outcomes Over 3 Decades

AU - Kilari, Deepak

AU - D'Souza, Anita

AU - Fraser, Raphael

AU - Qayed, Muna

AU - Davila, Omar

AU - Agrawal, Vaibhav

AU - Diaz, Miguel Angel

AU - Chhabra, Saurabh

AU - Cerny, Jan

AU - Copelan, Edward

AU - Farhadfar, Nosha

AU - Freytes, Cesar O.

AU - Gale, Robert Peter

AU - Ganguly, Siddhartha

AU - Hildebrandt, Gerhard C.

AU - Holmberg, Leona

AU - Kamble, Rammurti T.

AU - Kapoor, Prashant

AU - Lazarus, Hillard

AU - Lee, Cindy

AU - Murthy, Hemant S.

AU - Naik, Seema

AU - Nishihori, Taiga

AU - Saad, Ayman

AU - Savani, Bipin N.

AU - Seo, Sachiko

AU - Warwick, Anne

AU - Wirk, Baldeep

AU - Yared, Jean A.

AU - Nieto, Yago

AU - Hari, Parameswaran

PY - 2019/6/1

Y1 - 2019/6/1

N2 - 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.

AB - 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.

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