HIGH-DOSE CHEMOTHERAPY AS SALVAGE TREATMENT IN GERM-CELL TUMORS - A MULTIVARIATE-ANALYSIS OF PROGNOSTIC VARIABLES

Purpose: To identify prognostic variables for response and survival in mole patients with relapsed or refractory germ cell tumors treated wi th high-dose chemotherapy (HDCT) and hematopoietic progenitor cell sup port. Patients and Methods: Three hundred ten patients treated with HD CT at four centers in the United States and Europe were retrospectivel y evaluated, Univariate and multivariate analysis of patient, disease, and treatment characteristics were used for comparisons of response r ates and failure-free survival (FFS). Results: The actuarial FFS rate was 32% at 1, 30% at 2, and 29% at 3 years, Multivariate analysis iden tified progressive disease before HDCT, mediastinal nonseminomatous pr imary 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 variable s for FFS after HDCT. These variables were used to identify patients w ith good, intermediate, and poor prognoses. In the good-risk category, the predicted FFS rate at 2 years was 51%, compared with 27% and 5% i n the intermediate-risk and poor-risk categories (P < .001). The incre ased risk for treatment failure was due to both a significantly lower rate of favorable responses and a significantly higher rate of relapse s. Within the prognostic categories, the particular HDCT regimen or hi gher dosages of carboplatin or etoposide did not have a significant in fluence on treatment outcome. Conclusion: Prognostic variables far tre atment response after HDCT can be identified. The proposed prognostic model might help to optimize the use of HDCT in germ cell rumors and w arrants validation in future trials.