Open Access

Introduction: Clinical stage 1 (CS1) nonseminomatous (NS) germ cell tumors involve a 30% probability of relapse upon surveillance. Adjuvant chemotherapy with one course of bleomycin, etoposide, and cisplatin (1xBEP) can reduce this risk to <5%. However, 1xBEP results are based solely on five controlled trials from high-volume centers. We analyzed the outcome in a real-life population. Patients and Methods: In a multicentric international study, 423 NS CS1 patients receiving 1xBEP were retrospectively evaluated. Median follow-up was 37 (range, 6–89) months. Primary end points were relapse-free and overall survival evaluated after 5 years. We also looked at associations of relapse with clinico-pathological factors using stratified Kaplan–Meier methods and Cox regression models. Treatment modality and outcome of recurrences were analyzed descriptively. Results: The 5-year relapse-free survival rate was 96.2%. Thirteen patients (3.1%; 95% confidence interval, 1.65–5.04%) relapsed after a median time of 13 months, of which 10 were salvaged (77%). Relapses were mostly confined to retroperitoneal nodes. Three patients succumbed, two to disease progression and one to toxicity of chemotherapy. Pathological stage >pT2 was significantly associated with relapse rate. Conclusion: The relapse rate of 3.1% found in this population of NS CS1 patients treated with 1xBEP at the routine care level was not inferior to the median rate of 2.3% reported from a meta-analysis of controlled trials. Also, the cure rate of relapses of 77% is consistent with the previously reported rate of 80%. This study clearly shows that the 1xBEP regimen represents a safe treatment for NS CS1 patients.

Whether patients with acute myeloid leukemia (AML) harboring Nucleophosmin mutations (NPM1mut) with measurable residual disease (MRD) should undergo allogeneic stem cell transplantation (alloSCT) in complete remission (CR) remains subject of debate. This study aimed to assess whether the presence of bone marrow (BM) NPM1mut MRD, detected using a RT-qPCR assay with a sensitivity of 10-5, could influence the benefit derived from alloSCT. Data from four German transplantation centers were analyzed including 174 AML NPM1mut patients who underwent a first alloSCT between 2011-2022. Among 122 patients transplanted in complete remission (CR), pre-alloSCT MRD was positive in 54%. After alloSCT, the cumulative rate of BM MRD negativity increased from 65% by day +30 to 73% by day +100, with FLT3-ITD and ELN risk profile significantly impacting on MRD conversion rate at day +30. No significant difference in leukemia-free survival (LFS) and overall survival (OS) based on pre-transplant MRD status (3y LFS MRD+ 60% vs MRD- 74%, HR 1.5, p=0.28; 3y OS MRD+ 68% vs MRD- 78%, HR 1.42, p=0.39) was observed. Outcomes between MRD persistence and molecular relapse did not differ (p=0.8). Whereas adverse molecular risk features (HR 4.69, p=0.003) and relapsed/refractory disease (HR 2.83/3.59, p=0.005/0.001) were associated with unfavorable prognosis, administration of post-transplant maintenance improved survival in multivariable analysis (HR 0.48, p=0.06). Our findings suggest that in patients with NPM1mut AML MRD positivity as assessed per qPCR at time of transplant does not impact posttransplant outcomes of NPM1mut AML.