Marrow-ablative high-dose chemo (AuHCR) plus re-irradiation links to higher 3-year OS in relapsed CNS NGGCT

A multinational retrospective series of relapsed/refractory central nervous system nongerminomatous germ cell tumors (NGGCT) evaluated marrow-ablative high-dose chemotherapy with autologous hematopoietic stem cell rescue (HDCx+AuHCR) and re-irradiation as salvage strategies (n=30; relapse n=20, refractory n=10; median age 12 years; median time-to-relapse 12 months). HDCx was associated with improved OS (univariable HR 0.08, p=0.001; multivariable HR 0.111, p=0.006), while re-irradiation showed a borderline association (HR 0.403, p=0.051); 3-year OS was 76% with HDCx vs 5.3% without, and 33% with re-irradiation vs 17% without (p<0.05). All survivors (10/30) had achieved a complete response at end of therapy (6 received both HDCx and re-irradiation), aligning with the broader recurrent pediatric CNS GCT salvage paradigm where achieving CR and consolidating with HDCx±RT is often pursued, albeit with limited prospective data in this rare setting.