Leukemia following treatment of germ cell tumors in men.

We investigated the incidence of leukemia occurring subsequent to the treatment of germ cell tumors in men at our institution over a 30-year interval and found four patients with acute nonlymphocytic leukemia (ANLL) and one patient with chronic myelomonocytic leukemia. The relative risk (observed/expected cases) estimates for the development of leukemia ranged from 13.7 (P = .0005) in the total population to 50.1 (P = .0001) in the group treated with cytotoxic agents alone. All three patients with ANLL treated with contemporary antileukemic therapy had complete responses, with survivals of 7, 29, and 133 + months. In a review of the literature, 14 additional cases of germ cell tumors were found in which the men subsequently developed leukemia. It is concluded that leukemia following germ cell tumors is increased in incidence and is likely to be treatment induced. Complete responses and long-term survival are possible in secondary leukemia and aggressive antileukemic therapy should be given.

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Long-term survival in malignant intracranial germ-cell tumors: a report of two cases and a review of the literature

Child s Nervous System ◽

10.1007/bf00306201 ◽

1993 ◽

Vol 9 (7) ◽

pp. 431-436 ◽

Cited By ~ 14

Author(s):

Noboru Sakai ◽

Hiromu Yamada ◽

Takashi Andoh ◽

Yasuaki Nishimura ◽

Shuji Niikawa

Keyword(s):

Germ Cell ◽

Germ Cell Tumors ◽

Review Of The Literature ◽

Term Survival ◽

Long Term Survival ◽

Intracranial Germ Cell Tumors

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Faculty Opinions recommendation of Impact of clinical, cytogenetic, and molecular profiles on long-term survival after transplantation in patients with chronic myelomonocytic leukemia.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.736177851.793563520 ◽

2019 ◽

Author(s):

Francesco Onida

Keyword(s):

Chronic Myelomonocytic Leukemia ◽

Term Survival ◽

Long Term Survival ◽

Molecular Profiles ◽

Myelomonocytic Leukemia

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Impact of Teratoma on the Cumulative Incidence of Disease-Related Death in Patients With Advanced Germ Cell Tumors

Journal of Clinical Oncology ◽

10.1200/jco.18.01608 ◽

2019 ◽

Vol 37 (26) ◽

pp. 2329-2337 ◽

Cited By ~ 4

Author(s):

Samuel A. Funt ◽

Sujata Patil ◽

Darren R. Feldman ◽

Robert J. Motzer ◽

Dean F. Bajorin ◽

...

Keyword(s):

Germ Cell ◽

Cumulative Incidence ◽

Mature Teratoma ◽

Germ Cell Tumors ◽

Adverse Outcomes ◽

Term Survival ◽

Risk Status ◽

Primary Tumors ◽

Platinum Based Chemotherapy

PURPOSE In men with metastatic germ cell tumors (GCTs), risk-directed treatment is determined, in part, by a distinction between seminoma and nonseminomatous GCT (NSGCT). The importance of NSGCT cell type is uncertain. We evaluated the long-term impact of teratoma on survival in patients with NSGCT. METHODS Prechemotherapy, primary tumors from patients who received platinum-based chemotherapy were studied, and the histology was confirmed by a genitourinary pathologist. The cumulative incidence of disease-related death (CIDD) was the primary end point, and a competing-risk analysis was performed. RESULTS Tumors were available from 232 patients, including 193 with NSGCT. An element of teratoma was present in 82 NSGCT primary tumors (42%). With a median follow-up of 17 years (range, 0.3 to 35 years), 58 patients with NSGCT died, 47 as a result of GCT and 11 as a result of other causes. Most GCT deaths occurred within the first 5 years and were associated with pretreatment risk status ( P < .001). Death as a result of other causes rose steadily after 15 years and was not associated with risk status ( P = .66). A higher CIDD was observed in patients who had NSGCT with teratoma than those with NSGCT without teratoma and seminoma (5-year CIDD rate, 27.4%, 17.4%, and 10.3%, respectively; P = .03). A higher CIDD was observed in patients who had NSGCT with mature teratoma compared with those with either NSGCT with immature teratoma or NSGCT without teratoma (5-year CIDD rate, 38.1%, 19.9%, and 17.4%, respectively; P = .01). CONCLUSION The presence of teratoma, particularly mature teratoma, in an NSGCT primary tumor is associated with a higher CIDD, consistent with the hypothesis that differentiation is associated with adverse outcomes. Death as a result of non-GCT causes is not associated with risk status and must be separated from GCT death when evaluating long-term survival.

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Outcome of Patients With Residual Germ Cell or Non-Germ Cell Malignancy After Resection of Primary Mediastinal Nonseminomatous Germ Cell Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2004.07.102 ◽

2004 ◽

Vol 22 (7) ◽

pp. 1195-1200 ◽

Cited By ~ 28

Author(s):

Bryan P. Schneider ◽

Kenneth A. Kesler ◽

Jo Ann Brooks ◽

Constantin Yiannoutsos ◽

Lawrence H. Einhorn

Keyword(s):

Germ Cell ◽

Residual Disease ◽

Cell Cancer ◽

Elevated Serum ◽

Germ Cell Tumors ◽

Term Survival ◽

Poor Risk Patient ◽

Nonseminomatous Germ Cell Tumor ◽

Alive With Disease

PurposeTo identify prognostic variables and outcomes in patients with primary mediastinal nonseminomatous germ cell tumor (PMNSGCT) with postchemotherapy resection of persistent cancer.Patients and MethodsForty-seven consecutive patients with residual cancer after resection of PMNSGCT were retrospectively reviewed. Univariate comparisons were performed.ResultsAt diagnosis, 43 patients had elevated serum tumor markers (STMs), and 20 had extramediastinal disease. At resection, 21 patients had elevated STMs. After resection, 26 patients had germ cell tumors (GCT), 12 had malignant transformation of teratoma with elements of non-GCT, and nine had both GCT and non-GCT. Sixteen of 47 patients continuously have no evidence of disease (NED). This includes eight of 26 patients with GCT histology and two of 12 patients with non-GCT histology. Of 27 patients with mediastinal-only disease at presentation, 14 have continuously NED. Of 20 patients with extramediastinal disease at presentation, two have continuously NED. Seven of 21 patients with elevated STMs at time of resection have continuously NED. Sixteen patients received adjuvant chemotherapy, and seven have continuously NED. Overall, 16 of 47 patients have continuously NED, an additional four patients have NED with further therapy (currently NED), two patients are alive with disease, 23 patients died of disease, and two patients died postoperatively.ConclusionThe presence of elevated STMs at resection does not appear to alter outcome if residual disease is completely resected. In this poor-risk patient population, surgical resection of persistent cancer, even in the presence of elevated STMs, can still achieve long-term survival.

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Results of Treatment After Relapse From High-Dose Chemotherapy in Germ Cell Tumors

Journal of Clinical Oncology ◽

10.1200/jco.2000.18.6.1181 ◽

2000 ◽

Vol 18 (6) ◽

pp. 1181-1186 ◽

Cited By ~ 65

Author(s):

Pierluigi Porcu ◽

Sumeet Bhatia ◽

Matt Sharma ◽

Lawrence H. Einhorn

Keyword(s):

Germ Cell ◽

Response Rate ◽

Objective Response ◽

Germ Cell Tumors ◽

High Dose Chemotherapy ◽

Salvage Treatment ◽

High Dose ◽

Term Survival ◽

Platinum Based Chemotherapy

PURPOSE: To identify therapy-related or patient-related characteristics that predict response and long-term survival after failure of high-dose chemotherapy (HDCT) for germ cell tumors (GCT). PATIENTS AND METHODS: Between 1986 and 1997, 101 GCT patients relapsed after high-dose carboplatin and etoposide (VP-16) at Indiana University (Indianapolis, IN). Median time to relapse was 10 months (range, 1 to 17 months). HDCT was the first salvage treatment in 29 patients and second or later salvage treatment in 72 patients. RESULTS: Fifty-four of 101 patients received post-HDCT treatment. Of these, 47 received chemotherapy, alone (n = 35) or in combination with surgery (n = 12). Seven patients underwent surgery alone. There were only 12 objective responses (three complete and nine partial responses) for 66 chemotherapy regimens given to 47 patients, for an overall response rate of 18.2%. Fifteen patients received platinum-based chemotherapy, with only one objective response. Chemotherapy was discontinued in 17% of cases because of toxicity. A longer interval between HDCT and post-HDCT treatment was the only variable that was associated with response. Five patients (4.9%) are disease-free at 30, 53, 57, 85, and 93 months after relapse. Of these, three responded to oral VP-16 and underwent resection of residual mediastinal, retroperitoneal, and inguinal cancer, respectively. One had resection of residual mediastinal yolk sac tumor, followed by oral VP-16. One relapsed with teratoma and received thoracoabdominal resection without chemotherapy. CONCLUSION: Patients who experience disease progression after HDCT often receive further chemotherapy and/or surgery. Chemotherapy resulted in a response rate of less than 20%, with only three complete responses. All of the long-term survivors (4.9%) had surgery as a component of their post-HDCT regimen.

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