| Autor: |
Villela NC; 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., Seber A; 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., Macedo CRPD; 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., Zecchin VG; Department of Pediatric Stem Cell Transplantation, Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil., Guimarães RFDC; Department of Pediatric Stem Cell Transplantation, Hospital Samaritano, São Paulo, Brazil., Faria TMV; Brazilian Germ Cell Pediatric Study Group, Hospital de Amor, São Paulo, Brazil., Vidal DO; Brazilian Germ Cell Pediatric Study Group, Hospital de Amor, São Paulo, Brazil., Jorge GEM; Brazilian Germ Cell Pediatric Study Group, Hospital de Amor, São Paulo, Brazil.; Pediatric Oncology, Children's Cancer Hospital, Hospital de Amor, São Paulo, Brazil., Navarro G; Department of Stem Cell Transplantation, Hospital de Amor, São Paulo, Brazil., Lopes LF; 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. |
| Abstrakt: |
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. |
