Introduction: Treatment options for primary refractory or relapsed germ cell tumours (GCT) include conventional chemotherapy or high-dose chemotherapy with autologous stem cell support (HDCT-ASCT). We report retrospective data on all patients who received HDCT-ASCT at Peter MacCallum Cancer Centre from 2000-2012.

Methods: Case records were retrospectively analysed for baseline characteristics, treatment related toxicity and disease responses. The Kaplan-Meier method was applied to explore progression free survival (PFS) and overall survival (OS).

Results: 17 of 18 patients who received HDCT-ASCT for GCT had sufficient data for inclusion. Median age at diagnosis was 34 (range: 21-46), with 76% having non-seminoma, 41% primary refractory disease, 13/17 receiving HDCT-ASCT at 1^st relapse and 9/17 having high/very high disease prior to salvage according to the International Prognostic Factors Study Group (IPFSG). The most common regimen utilised was TICE (paclitaxel/ifosfamide followed by carboplatin/etoposide). With median follow-up of 37 months, 47 cycles of HDCT-ASCT (median 3 per patient) were administered with an average stem cell dose of 4.91 of CD34x10^6/kg (2.04-15.25 of CD34x10^6/kg). The median duration of Grade 4 (G4) neutropenia was 11 days (range 9-17) with febrile neutropenia occurring in 90% resulting in 4 ICU admissions (8%). Median duration of G4 thrombocytopenia was 10 days (range 8-19) requiring a median of 2.3 pooled platelets bags (0-33). Transplant-related mortality (TRM) occurred in 1 patient, secondary to veno-occlusive disease. 27% of ASCT cycles were associated with G3 or G4 mucositis as assessed by a requirement for TPN or opioids (median 5 TPN days (0-23)). 2 year PFS and OS rates were 59% and 69% (Graph 1). PFS and OS according to the IPFSG is shown in Graph 2.

Conclusion: HDCT with ASCT for GCT is deliverable, with a TRM and toxicity profile consistent with other published series. It has an encouraging PFS/OS in a poor-prognosis patient cohort.

Graph 1

Graph 2