ORIGINAL ARTICLE Long-term follow-up of patients undergoing auto-SCT for advanced germ cell tumour: a multicentre cohort study MD Seftel 1 , K Paulson 1 , R Doocey 2 , K Song 3,4 , P Czaykowski 1 , C Coppin 4 , D Forrest 3,4 , D Hogge 3,4 , C Kollmansberger 4 , CA Smith 3,4 , JD Shepherd 3,4 , CL Toze 3,4 , N Murray 4 , H Sutherland 3,4 , S Nantel 3,4 , TJ Nevill 3,4 and MJ Barnett 3,4 1 Section of Medical Oncology/Hematology, University of Manitoba and CancerCare Manitoba, Winnipeg, Manitoba, Canada; 2 Department of Haematology, Auckland City Hospital, Auckland, New Zealand; 3 Leukemia/BMT Program of British Columbia, Vancouver, British Columbia, Canada and 4 University of British Columbia and British Columbia Cancer Agency, Vancouver, British Columbia, Canada Failure of cisplatin-based chemotherapy in advanced germ cell tumour (GCT) is associated with a poor outcome. High-dose chemotherapy and auto-SCT is one therapeutic option, although the long-term outcome after this procedure is unclear. We conducted a multicentre cohort study of consecutive patients undergoing a single auto- SCT for GCT between January 1986 and December 2004. Of 71 subjects, median follow-up is 10.1 years. OS at 5 years is 44.7% (95% confidence interval (CI) 32.9–56.5%) and EFS is 43.5% (95% CI 31.4–55.1%). There were seven (10%) treatment-related deaths within 100 days of auto-SCT. Three (4.2%) patients developed secondary malignancies. Of 33 relapses, 31 occurred within 2 years of auto-SCT. Two very late relapses were noted 13 and 11 years after auto-SCT. In multivariate analysis, favourable outcome was associated with IGCCC (International Germ Cell Consensus Classification) good prognosis disease at diagnosis, primary gonadal disease and response to salvage chemotherapy. We conclude that auto-SCT results in successful outcome for a relatively large subgroup of patients with high-risk GCT. Late relapses may occur, a finding not previously reported. Bone Marrow Transplantation (2011) 46, 852–857; doi:10.1038/bmt.2010.250; published online 1 November 2010 Keywords: germ cell tumour; high-dose chemotherapy; auto-SCT Introduction With the advent of platinum-based chemotherapy, advanced germ cell tumour (GCT) has been converted from a dis- ease that was usually fatal to a potentially curable one. 1 Overall cure rates with cisplatin-based chemotherapy regi- mens, in conjunction with aggressive resection of residual disease, may be as high as 75%. However, even with these advances, incomplete remission, refractory disease or relapse may occur. The optimal approach for these high- risk patients is still unclear; options include salvage chemotherapy, radiation therapy and surgery to debulk remaining tumour mass. Several non-randomized studies have examined the role of high-dose chemotherapy with autologous blood or marrow transplantation in the salvage setting (auto-SCT). 2–5 These studies suggest that auto-SCT can induce CR and prolonged disease-free survival. 2,6,7 One randomized controlled trial comparing standard salvage chemotherapy with auto-SCT showed no significant benefit from auto-SCT. 8 However, median follow-up in this study was relatively short (45 months, range 22 days to 7.5 years). Recent cohort studies 9 have shown that sequential auto- SCT (multiple cycles of high-dose chemotherapy each followed by stem cell infusion) may be a preferable option to single auto-SCT. 9,10 We present the results of a cohort of 71 patients who received a single auto-SCT for GCT at two Canadian transplant centres. Uniquely, we were able to examine very long-term outcomes including late toxicities and relapses. Materials and methods The Leukemia/Bone Marrow Transplant Programme at the British Columbia Cancer Agency and the Blood and Marrow Transplant Programme at CancerCare Manitoba have the responsibility of evaluating and treating all candidates for haematopoietic transplantation in the Canadian provinces of British Columbia and Manitoba, respectively. Both these programmes prospectively record detailed demographic and clinical data for transplant patients. Using these data, we identified all patients who underwent auto-SCT for advanced seminomatous or non- seminomatous GCT between March 1986 and February Received 29 March 2010; revised 17 August 2010; accepted 20 August 2010; published online 1 November 2010 Correspondence: Dr MD Seftel, Department of Medical Oncology/ Hematology, CancerCare Manitoba, ON2076 675 Mcdermot Avenue, Winnipeg, Manitoba, Canada R3E0V9. E-mail: matthew.seftel@cancercare.mb.ca Bone Marrow Transplantation (2011) 46, 852–857 & 2011 Macmillan Publishers Limited All rights reserved 0268-3369/11 www.nature.com/bmt