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Villela NC, Seber A, Macedo CRPD, Zecchin VG, Guimarães RFDC, Faria TMV, Vidal DO, Jorge GEM, Navarro G, Lopes LF. High-dose chemotherapy with autologous stem cell transplantation for patients with extracranial germ cell tumors - experience of two Brazilian pediatric centers. Pediatr Hematol Oncol 2023; 40:539-553. [PMID: 36940088 DOI: 10.1080/08880018.2023.2187497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 02/13/2023] [Accepted: 02/17/2023] [Indexed: 03/21/2023]
Abstract
Malignant extracranial germ cell tumors (GCTs) are rare in pediatric patients and are usually extremely sensitive to chemotherapy. Relapsed or refractory tumors, although rare, established the need for second-line therapies, including high-dose chemotherapy with autologous stem cell transplantation (HDCT/ASCT). However, there are few data on its use in children with GCTs. We present a retrospective analysis of all patients diagnosed with extracranial GCTs who received HDCT/ASCT at two Brazilian pediatric cancer centers from May 1999 to December 2019. We identified a total of 34 patients with a median age at diagnosis of 2.8 years (range, 0 to 18.8), who received HDCT/ASCT. Most patients (73%) received carboplatin, etoposide and melphalan (CEM) as a HDCT regimen. Fourteen patients received a second-line conventional dose chemotherapy (CDCT), 14 received a third-line CDCT and five received even a fourth-line CDCT prior to HDCT/ASCT. After a median follow-up of 22.7 months (range, 0.3 to 198.1), 16 patients had died after tumor relapse/progression and 2 patients died from HDCT/ASCT toxicity. We observed a 5-year OS of 47.1% and 5-year EFS of 44.1%. The 5-year OS for patients referred for HDCT/ASCT with progressive disease was 10% compared to 62.5% for those who achieved disease control before HDCT/ASCT (p = 0.001). In our experience, heavily pretreated children and adolescents with extracranial GCTs achieved considerable survival rates with HDCT/ASCT since, at least, partial control of their disease was possible before starting HDCT/ASCT. The role of HDCT/ASCT in pediatric patients with GCTs should be investigated in prospective trials.
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Affiliation(s)
- Neysimelia Costa Villela
- Department of Stem Cell Transplantation, Children's Cancer Hospital, Hospital de Amor, São Paulo, Brazil
- Brazilian Germ Cell Pediatric Study Group, Hospital de Amor, São Paulo, Brazil
| | - Adriana Seber
- Brazilian Germ Cell Pediatric Study Group, Hospital de Amor, São Paulo, Brazil
- Institute of Pediatric Oncology/Support Group for Adolescents and Children With Cancer, Federal University of Sao Paulo, Sao Paulo, Brazil
- Department of Pediatric Stem Cell Transplantation, Hospital Samaritano, São Paulo, Brazil
| | - Carla Renata Pacheco Donato Macedo
- Brazilian Germ Cell Pediatric Study Group, Hospital de Amor, São Paulo, Brazil
- Institute of Pediatric Oncology/Support Group for Adolescents and Children With Cancer, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Victor Gottardello Zecchin
- Department of Pediatric Stem Cell Transplantation, Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil
| | | | | | - Daniel Onofre Vidal
- Brazilian Germ Cell Pediatric Study Group, Hospital de Amor, São Paulo, Brazil
| | - Gisele Eiras Martins Jorge
- Brazilian Germ Cell Pediatric Study Group, Hospital de Amor, São Paulo, Brazil
- Pediatric Oncology, Children's Cancer Hospital, Hospital de Amor, São Paulo, Brazil
| | - George Navarro
- Department of Stem Cell Transplantation, Hospital de Amor, São Paulo, Brazil
| | - Luiz Fernando Lopes
- Brazilian Germ Cell Pediatric Study Group, Hospital de Amor, São Paulo, Brazil
- Chairman, Brazilian Germ Cell Pediatric Study Group, Hospital de Amor, São Paulo, Brazil
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Gössi F, Spahn M, Samaras P, Beyer J, Schardt J, Pabst T. Response to first-line treatment and histology are associated with achieving complete remission after the first salvage high-dose chemotherapy in relapsing germ cell tumor patients. Bone Marrow Transplant 2018; 53:820-825. [DOI: 10.1038/s41409-018-0089-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 12/07/2017] [Accepted: 12/20/2017] [Indexed: 11/09/2022]
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