METHODS: The prospectively maintained Indiana University germ cell tumor database identified 32 patients with primary mediastinal nonseminomatous germ cell tumor who progressed after first-line cisplatin-based combination chemotherapy and received HDCT and PBSCT between 2006 and 2021. Therapy included two consecutive courses of HDCT consisting of 700 mg/m2 carboplatin and 750 mg/m2 etoposide, each for 3 consecutive days, and each followed by PBSCT. A second course was not given if the patient experienced progressive disease or prohibitive toxicity. Progression-free survival and overall survival were analyzed using the Kaplan-Meier method. Medians with 95% confidence intervals were also calculated along with 2-year probabilities.
RESULTS: The median age at HDCT was 30 years (range, 18-61 years). With a median follow-up of 4.7 years (range, 1-14 years), the 2-year progression-free survival rate was 31% (95% confidence interval, 16%-47%), and the 2-year overall survival rate was 35% (95% confidence interval, 19%-52%). At last follow-up, nine patients (28%) remained without evidence of disease, including two platinum-refractory patients and two patients who were receiving HDCT as third-line therapy. There were three treatment-related deaths.
CONCLUSIONS: Salvage HDCT and PBSCT is an active combination in patients who have relapsed primary mediastinal nonseminomatous germ cell tumor with curative potential and prolonged survival, including in platinum-refractory and third-line settings. The authors recommend this approach for initial salvage chemotherapy in this patient population.
方法:前瞻性维护的印第安纳大学生殖细胞肿瘤数据库确定了32例原发性纵隔非精原细胞生殖细胞肿瘤患者,这些患者在以顺铂为基础的一线联合化疗后进展,并在2006年至2021年间接受了HDCT和PBSCT。治疗包括连续两个疗程的HDCT,包括700mg/m2卡铂和750mg/m2依托泊苷,每个连续3天,然后是PBSCT。如果患者出现进行性疾病或禁止性毒性,则不给予第二疗程。使用Kaplan-Meier方法分析无进展生存期和总生存期。还计算了95%确认间隔的中位数和2年概率。
结果:HDCT的中位年龄为30岁(范围,18-61岁)。中位随访时间为4.7年(范围,1-14年),2年无进展生存率为31%(95%置信区间,16%-47%),2年总生存率为35%(95%置信区间,19%-52%)。在最后的随访中,9名患者(28%)仍然没有疾病的证据,包括2例铂类难治性患者和2例接受HDCT三线治疗的患者.有3例与治疗相关的死亡。
结论:挽救性HDCT和PBSCT是复发性原发性纵隔非精原细胞生殖细胞肿瘤患者的积极组合,具有治愈潜力和延长生存期,包括铂金耐火材料和第三线设置。作者推荐这种方法用于该患者人群的初始挽救化疗。