Individual Treatment with Stem Cell Rescue in Patients with Germ-Cell Tumors. Results of One Centrum

Konference: 2006 48th ASH Annual Meeting - účast ČR

Kategorie: Genitourinární nádory

Téma: Publikace ve sborníku

Číslo abstraktu: 5429

Autoři: MUDr. Jana Nepomucká, CSc.; prof. MUDr. Jitka Abrahámová, DrSc.; MUDr. Martin Foldyna; MUDr. Zuzana Donátová; MUDr. Drahomíra Kordíková; Ludmila Pagacova; Jan Kalanin; MUDr. Marcela Greplová; MUDr. Markyta Bártová

Background: Treatment with high dose chemotherapy and autologous stem cell rescue in pacients with poor risk germ cell tumors is still controversial. Results of multicentric randomized EBMT study IT 94 presented at ASCO 2002 show benefit in 1-year EFS in high dose arm (52% versus 48%), 3-year EFS was the same in both arms ( 53%) in salvage treatment. Individual treatment with stem cell rescue as upfront treatment offers a survival benefit.
Methods:Autologous stem cell rescue was provided in our center, from September 1997 to May 2006 to 52 patients. High dose chemotherapy was indicated to 32 patients in salvage setting after 2nd line of treatment ( VeIP ) and to 20 patients as upfront treatment after 1st line treatment ( BEP ). Median age was 29 years and tumor markers were elevated: HCG in 9 pts, AFP in 13 pts.
Stem cell mobilization was performed after the 3rd cycle of VeIP or BEP in combination with G-CSF. The amount of CD34+ cell/kg b.w. was between 2,0 - 13.4x106. High - dose conditioning regimen CARBOPEC (carboplatin 1600 2 200 mg/m2 , etoposide 1 800mg/m2 , cyclophosphamide 6 400 mg/m2) was used. The treatment was well tolerated without transplant related mortality.

Results: WHO criteria non - hematological toxicity was predominantly grade 2 to 3. Engraftment was rapid, recovery of hematopoiesis in neutrofils over 1.0x109/l and platelets over 50x109/l was reached an average on days +10 and +13 respectively. Additional post-transplant treatment for persistence, progression or relaps had 20 patients ( 8pts had 2nd line treatment VEIP, 12pts had 3nd line treatment with paclitaxel+gemcitabine and 5 pts had retroperitoneal lymfadenectomy).
The follow up period ranges from 3 to 99 months, at present 38 (73 %) patients are alive, 14 (27 %) pts died. Median TTP of all pts is 10 months, median OS of all pts is 39 months. Median DFS of surviving pts is 38 months.
Conclusion: high-dose chemotherapy with autologous stem cell rescue in patients with poor risk germ cell tumors is feasible and beneficial method of the individual treatment. High-dose chemotherapy as upfront treatment for poor prognosis germ cell tumors and as salvage treatment in good risk pts seems to be good possibility of the individual treatment.
Supported by Internal Grant Agency of The Czech Ministry of Health, Grant No.8442-3 /2005.

Datum přednesení příspěvku: 9. 12. 2006