Survival outcomes and toxicity in patients 40 years old or older with relapsed metastatic germ cell tumors treated with high-dose chemotherapy and peripheral blood stem cell transplantation

BACKGROUND High-dose chemotherapy (HDCT) plus peripheral blood stem cell transplantation (PBSCT) is effective salvage therapy for relapsed metastatic germ cell tumors (GCTs) but has potential toxicity. Historically, an age of >= 40 years has been associated with greater toxicity and worse outcomes. METHODS This is a retrospective analysis of 445 consecutive patients with relapsed GCT treated with HDCT and PBSCT with tandem cycles at Indiana University from between 2004-2017 per our institutional regimen. Kaplan-Meier methods and log-rank tests were used for progression-free survival (PFS) and overall survival (OS) analysis. RESULTS A total of 329 patients were <40 years of age, whereas 116 patients were >= 40 years of age; HDCT was used as second-line therapy in 85% and 79%, respectively. Median follow-up time was 42.5 months (range, 0.3-173.4 months). Grade >= 3 toxicities were similar between either group, except for greater pulmonary (P = .02) and renal toxicity (P = .01) in the >= 40-years-of-age group. Treatment-related mortality was similar between both age groups: 10 patients (3%) in the <40-years-of-age group and 4 patients (3.5%) in >= 40-years-of-age group died from complications of HDCT. Two-year PFS for <40 years of age versus >= 40 years of age was 58.7% versus 59.6% (P = .76) and 2-year OS was 63.9% versus 61.5% (P = .93). Factors predicting worse PFS included Eastern Cooperative Oncology Group performance status >= 1, platinum refractory disease, nonseminoma histology, and not completing 2 cycles of HDCT. Age was not an independent predictor of worse outcomes. CONCLUSIONS HDCT plus PBSCT is effective salvage therapy in patients >= 40 years of age with relapsed metastatic GCT. Patients >= 40 years of age experience similar rates of toxicity and treatment-related mortality as those <40 years of age.

Automated summary

Age is not an independent predictor of worse outcomes for patients with relapsed metastatic germ cell tumors. Patients aged 40 and above experience similar rates of toxicity and treatment-related mortality as those under 40 when treated with HDCT and PBSCT.