Prognostic factors for patients with relapsed central nervous system nongerminomatous germ cell tumors

Pediatr Blood Cancer. 2022 Jan;69(1):e29365. doi: 10.1002/pbc.29365. Epub 2021 Sep 24.


We aimed toidentify prognostic factors that may help better understand the behavior of relapsed central nervous system nongerminomatous germ cell tumors. We identified nine studies, including 101 patients; 33 patients (33%) were alive 12 months post-initial relapse. Sixty percent of patients with serum/cerebrospinal fluid (CSF) alpha-fetoprotein (AFP) level ≤25 ng/mL at initial diagnosis were survivors compared with 28% among patients with serum/CSF AFP level >25 ng/mL (P = 0.01). Seventy-one percent of patients who achieved complete response/continued complete response (CR/CCR) by the end of therapy at relapse were survivors compared with 7% among patients who had less than CR/CCR (P < 0.0001). Forty-eight percent of patients who received marrow-ablative chemotherapy followed by autologous hematopoietic cell rescue (HDCx/AuHCR) following relapse were survivors compared with 12% among patients who did not receive HDCx/AuHCR (P = 0.0001). Local relapse site, gross total surgical resection, and radiotherapy at relapse were not associated with improved outcomes.

Keywords: Central nervous system; germ cell tumors; nongerminomatous germ cell tumors; recurrence; relapse.

Publication types

  • Review

MeSH terms

  • Antineoplastic Combined Chemotherapy Protocols
  • Central Nervous System
  • Central Nervous System Neoplasms* / therapy
  • Combined Modality Therapy
  • Humans
  • Neoplasm Recurrence, Local / therapy
  • Neoplasms, Germ Cell and Embryonal* / therapy
  • Prognosis
  • Testicular Neoplasms
  • alpha-Fetoproteins


  • alpha-Fetoproteins

Supplementary concepts

  • Nonseminomatous germ cell tumor