O’Neill AF, Xia C, Krailo MD, et al. - Via retrospectively analyzing data from Children's Oncology Group (COG) protocol AGCT0132, researchers determined whether there is a decline in the relationship between α-fetoprotein (AFP) and the result. For this analysis of AFP decline, 131 patients with germ cell tumors who were enrolled in COG protocol AGCT0132 were eligible. For patients with a satisfactory decline, the 3-year cumulative incidence of relapse was 11% and for patients with an unsatisfactory decline was 38%. This research is the first to demonstrate a link between AFP decline and the cumulative incidence of relapse in pediatric patients treated for germ cell tumors. Recognition of high-risk patients for relapse may enable early treatment intensification, which may influence future clinical trial design. Three-year overall survival for patients with a satisfactory decline compared with an unsatisfactory decline was not statistically significant.