High-dose chemotherapy as salvage treatment in germ cell tumors

A multivariate analysis of prognostic variables

J. Beyer, A. Kramar, R. Mandanas, W. Linkesch, A. Greinix, J. P. Droz, J. L. Pico, A. Diehl, C. Bokemeyer, H. J. Schmoll, C. R. Nichols, Lawrence Einhorn, W. Siegert

Research output: Contribution to journalArticle

277 Citations (Scopus)

Abstract

Purpose: To identify prognostic variables for response and survival in male patients with relapsed or refractory germ cell tumors treated with high- dose chemotherapy (HDCT) and hematopoietic progenitor cell support. Patients and Methods: Three hundred ten patients treated with HDCT at four centers in the United States and Europe were retrospectively evaluated. Univariate and multivariate analysis of patient, disease, and treatment characteristics were used for comparisons of response rates and failure-free survival (FFS). Results: The actuarial FFS rate was 32% at 1, 30% at 2, and 29% at 3 years. Multivariate analysis identified progressive disease before HDCT, mediastinal nonseminomatous primary tumor, refractory or absolute refractory disease to conventional-dose cisplatin, and human chorionic gonadotropin (HCG) levels greater than 1,000 U/L before HDCT as independent adverse prognostic variables for FFS after HDCT. These variables were used to identify patients with good, intermediate, and poor prognoses. In the good-risk category, the predicted FFS rate at 2 years was 51%, compared with 27% and 5% in the intermediate-risk and poor-risk categories (P <.001). The increased risk for treatment failure was due to both a significantly lower rate of favorable responses and a significantly higher rate of relapses. Within the prognostic categories, the particular HDCT regimen or higher dosages of carboplatin or etoposide did not have a significant influence on treatment outcome. Conclusion: Prognostic variables for treatment response after HDCT can be identified. The proposed prognostic model might help to optimize the use of HDCT in germ cell tumors and warrants validation in future trials.

Original languageEnglish (US)
Pages (from-to)2638-2645
Number of pages8
JournalJournal of Clinical Oncology
Volume14
Issue number10
StatePublished - 1996
Externally publishedYes

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Salvage Therapy
Germ Cell and Embryonal Neoplasms
Multivariate Analysis
Drug Therapy
Survival
Survival Rate
Carboplatin
Etoposide
Chorionic Gonadotropin
Hematopoietic Stem Cells
Treatment Failure
Cisplatin
Recurrence
Therapeutics

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Beyer, J., Kramar, A., Mandanas, R., Linkesch, W., Greinix, A., Droz, J. P., ... Siegert, W. (1996). High-dose chemotherapy as salvage treatment in germ cell tumors: A multivariate analysis of prognostic variables. Journal of Clinical Oncology, 14(10), 2638-2645.

High-dose chemotherapy as salvage treatment in germ cell tumors : A multivariate analysis of prognostic variables. / Beyer, J.; Kramar, A.; Mandanas, R.; Linkesch, W.; Greinix, A.; Droz, J. P.; Pico, J. L.; Diehl, A.; Bokemeyer, C.; Schmoll, H. J.; Nichols, C. R.; Einhorn, Lawrence; Siegert, W.

In: Journal of Clinical Oncology, Vol. 14, No. 10, 1996, p. 2638-2645.

Research output: Contribution to journalArticle

Beyer, J, Kramar, A, Mandanas, R, Linkesch, W, Greinix, A, Droz, JP, Pico, JL, Diehl, A, Bokemeyer, C, Schmoll, HJ, Nichols, CR, Einhorn, L & Siegert, W 1996, 'High-dose chemotherapy as salvage treatment in germ cell tumors: A multivariate analysis of prognostic variables', Journal of Clinical Oncology, vol. 14, no. 10, pp. 2638-2645.
Beyer J, Kramar A, Mandanas R, Linkesch W, Greinix A, Droz JP et al. High-dose chemotherapy as salvage treatment in germ cell tumors: A multivariate analysis of prognostic variables. Journal of Clinical Oncology. 1996;14(10):2638-2645.
Beyer, J. ; Kramar, A. ; Mandanas, R. ; Linkesch, W. ; Greinix, A. ; Droz, J. P. ; Pico, J. L. ; Diehl, A. ; Bokemeyer, C. ; Schmoll, H. J. ; Nichols, C. R. ; Einhorn, Lawrence ; Siegert, W. / High-dose chemotherapy as salvage treatment in germ cell tumors : A multivariate analysis of prognostic variables. In: Journal of Clinical Oncology. 1996 ; Vol. 14, No. 10. pp. 2638-2645.
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abstract = "Purpose: To identify prognostic variables for response and survival in male patients with relapsed or refractory germ cell tumors treated with high- dose chemotherapy (HDCT) and hematopoietic progenitor cell support. Patients and Methods: Three hundred ten patients treated with HDCT at four centers in the United States and Europe were retrospectively evaluated. Univariate and multivariate analysis of patient, disease, and treatment characteristics were used for comparisons of response rates and failure-free survival (FFS). Results: The actuarial FFS rate was 32{\%} at 1, 30{\%} at 2, and 29{\%} at 3 years. Multivariate analysis identified progressive disease before HDCT, mediastinal nonseminomatous primary tumor, refractory or absolute refractory disease to conventional-dose cisplatin, and human chorionic gonadotropin (HCG) levels greater than 1,000 U/L before HDCT as independent adverse prognostic variables for FFS after HDCT. These variables were used to identify patients with good, intermediate, and poor prognoses. In the good-risk category, the predicted FFS rate at 2 years was 51{\%}, compared with 27{\%} and 5{\%} in the intermediate-risk and poor-risk categories (P <.001). The increased risk for treatment failure was due to both a significantly lower rate of favorable responses and a significantly higher rate of relapses. Within the prognostic categories, the particular HDCT regimen or higher dosages of carboplatin or etoposide did not have a significant influence on treatment outcome. Conclusion: Prognostic variables for treatment response after HDCT can be identified. The proposed prognostic model might help to optimize the use of HDCT in germ cell tumors and warrants validation in future trials.",
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T2 - A multivariate analysis of prognostic variables

AU - Beyer, J.

AU - Kramar, A.

AU - Mandanas, R.

AU - Linkesch, W.

AU - Greinix, A.

AU - Droz, J. P.

AU - Pico, J. L.

AU - Diehl, A.

AU - Bokemeyer, C.

AU - Schmoll, H. J.

AU - Nichols, C. R.

AU - Einhorn, Lawrence

AU - Siegert, W.

PY - 1996

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N2 - Purpose: To identify prognostic variables for response and survival in male patients with relapsed or refractory germ cell tumors treated with high- dose chemotherapy (HDCT) and hematopoietic progenitor cell support. Patients and Methods: Three hundred ten patients treated with HDCT at four centers in the United States and Europe were retrospectively evaluated. Univariate and multivariate analysis of patient, disease, and treatment characteristics were used for comparisons of response rates and failure-free survival (FFS). Results: The actuarial FFS rate was 32% at 1, 30% at 2, and 29% at 3 years. Multivariate analysis identified progressive disease before HDCT, mediastinal nonseminomatous primary tumor, refractory or absolute refractory disease to conventional-dose cisplatin, and human chorionic gonadotropin (HCG) levels greater than 1,000 U/L before HDCT as independent adverse prognostic variables for FFS after HDCT. These variables were used to identify patients with good, intermediate, and poor prognoses. In the good-risk category, the predicted FFS rate at 2 years was 51%, compared with 27% and 5% in the intermediate-risk and poor-risk categories (P <.001). The increased risk for treatment failure was due to both a significantly lower rate of favorable responses and a significantly higher rate of relapses. Within the prognostic categories, the particular HDCT regimen or higher dosages of carboplatin or etoposide did not have a significant influence on treatment outcome. Conclusion: Prognostic variables for treatment response after HDCT can be identified. The proposed prognostic model might help to optimize the use of HDCT in germ cell tumors and warrants validation in future trials.

AB - Purpose: To identify prognostic variables for response and survival in male patients with relapsed or refractory germ cell tumors treated with high- dose chemotherapy (HDCT) and hematopoietic progenitor cell support. Patients and Methods: Three hundred ten patients treated with HDCT at four centers in the United States and Europe were retrospectively evaluated. Univariate and multivariate analysis of patient, disease, and treatment characteristics were used for comparisons of response rates and failure-free survival (FFS). Results: The actuarial FFS rate was 32% at 1, 30% at 2, and 29% at 3 years. Multivariate analysis identified progressive disease before HDCT, mediastinal nonseminomatous primary tumor, refractory or absolute refractory disease to conventional-dose cisplatin, and human chorionic gonadotropin (HCG) levels greater than 1,000 U/L before HDCT as independent adverse prognostic variables for FFS after HDCT. These variables were used to identify patients with good, intermediate, and poor prognoses. In the good-risk category, the predicted FFS rate at 2 years was 51%, compared with 27% and 5% in the intermediate-risk and poor-risk categories (P <.001). The increased risk for treatment failure was due to both a significantly lower rate of favorable responses and a significantly higher rate of relapses. Within the prognostic categories, the particular HDCT regimen or higher dosages of carboplatin or etoposide did not have a significant influence on treatment outcome. Conclusion: Prognostic variables for treatment response after HDCT can be identified. The proposed prognostic model might help to optimize the use of HDCT in germ cell tumors and warrants validation in future trials.

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