复发或难治性生殖细胞肿瘤的大剂量化疗联合自体干细胞移植：17例病例系列的结果及预后变量

High-dose chemotherapy with autologous stem cell transplantation in relapsed or refractory germ cell tumours: outcomes and prognostic variables in a case series of 17 patients.

作者信息

Lewin J, Dickinson M, Voskoboynik M, Collins M, Ritchie D, Toner G

机构信息

DHMO, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Ontrac, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.

出版信息

Intern Med J. 2014 Aug;44(8):771-8. doi: 10.1111/imj.12486.

DOI:10.1111/imj.12486

PMID:24893627

Abstract

BACKGROUND

Optimal therapy for men relapsing after initial chemotherapy for germ cell tumours (GCT) is poorly defined. Both conventional dose salvage regimens and high-dose chemotherapy with autologous stem cell transplantation (HDCT-ASCT) have been utilised.

AIMS

To examine patients who received HDCT-ASCT for relapsed GCT within a single Australian centre.

METHODS

Records between 2000 and 2012 were analysed for baseline characteristics, treatment-related toxicity and survival. Prognosis at the time of HDCT-ASCT was classified according to the International Prognostic Factors Study Group (IPFSG).

RESULTS

Seventeen patients received HDCT-ASCT, median age 34 (21-46), with 41% having primary refractory disease and 53% with high/very high risk disease by IPFSG. The most common regimen utilised was paclitaxel/ifosfamide followed by high-dose carboplatin/etoposide (TI-CE; n = 12). The median duration of grade 4 (G4) neutropenia was 11 days (range 9-17) with febrile neutropenia in 90% resulting in four intensive care unit admissions (8%). Median duration of G4 thrombocytopenia was 10 days (range 8-19) requiring a median of two pooled platelets bags (range 0-33) per episode. Transplant-related mortality occurred in one patient (veno-occlusive disease). Twenty-seven per cent of HDCT-ASCT cycles were associated with grade 3 mucositis (median total parenteral nutrition days = 5 (0-23)). Two-year progression-free survival (PFS) and overall survival (OS) rates were 59% and 71%. Patients who received HDCT-ASCT as second or subsequent relapse fared worse than those treated with HDCT-ASCT at first relapse (hazard ratio 0.23 (95% confidence interval: 0.04, 1.37; P-value 0.09). Three-year OS for those who received TI-CE at first relapse was 90%.

CONCLUSIONS

HDCT-ASCT for relapsed GCT is effective with acceptable toxicity. There was encouraging PFS/OS, particularly in a poor-prognosis cohort.

摘要

背景

对于初始化疗后复发的生殖细胞肿瘤（GCT）男性患者，最佳治疗方案尚未明确。传统剂量挽救方案和高剂量化疗联合自体干细胞移植（HDCT-ASCT）均已被采用。

目的

研究在澳大利亚单一中心接受HDCT-ASCT治疗复发GCT的患者。

方法

分析2000年至2012年间的记录，了解基线特征、治疗相关毒性和生存率。根据国际预后因素研究组（IPFSG）对HDCT-ASCT时的预后进行分类。

结果

17例患者接受了HDCT-ASCT，中位年龄34岁（21-46岁），41%为原发性难治性疾病，53%根据IPFSG为高/极高风险疾病。最常用的方案是紫杉醇/异环磷酰胺，随后是高剂量卡铂/依托泊苷（TI-CE；n = 12）。4级（G4）中性粒细胞减少的中位持续时间为11天（范围9-17天），90%的患者出现发热性中性粒细胞减少，导致4例入住重症监护病房（8%）。G4血小板减少的中位持续时间为10天（范围8-19天），每次发作中位需要两袋混合血小板（范围0-33袋）。1例患者发生移植相关死亡（静脉闭塞性疾病）。27%的HDCT-ASCT周期与3级粘膜炎相关（中位全胃肠外营养天数 = 5天（0-23天））。两年无进展生存率（PFS）和总生存率（OS）分别为59%和71%。接受HDCT-ASCT作为第二次或后续复发的患者比首次复发时接受HDCT-ASCT治疗的患者预后更差（风险比0.23（95%置信区间：0.04，1.37；P值0.09）。首次复发时接受TI-CE治疗的患者三年OS为90%。