High-dose chemotherapy followed by stem cell rescue for high-risk germ cell tumors: the Stanford experience

• Published in: Bone marrow transplantation (Basingstoke) Vol. 43; no. 7; pp. 547 - 552
• Main Authors: Agarwal, R, Dvorak, C C, Stockerl-Goldstein, K E, Johnston, L, Srinivas, S
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.04.2009; Nature Publishing Group
• Subjects: Adolescent; Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Autografts; Biological and medical sciences; Bone marrow; Bone marrow, stem cells transplantation. Graft versus host reaction; Cancer; Carboplatin; Carboplatin - administration & dosage; Care and treatment; Cell Biology; Chemotherapy; Child; Combined Modality Therapy; Cyclophosphamide - administration & dosage; Disease-Free Survival; Dosage; Etoposide; Etoposide - administration & dosage; Female; Germ cell tumors; Hematology; Hematopoietic Stem Cell Mobilization; Hematopoietic Stem Cell Transplantation; Hematopoietic stem cells; Hematopoietic Stem Cells - pathology; Humans; Internal Medicine; Male; Medical prognosis; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Neoplasms, Germ Cell and Embryonal - drug therapy; Neoplasms, Germ Cell and Embryonal - therapy; original-article; Patient outcomes; Patients; Platinum; Public Health; Risk groups; Stem cell transplantation; Stem Cells; Survival; Thermal resistance; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation; Transplants; Tumors; United States; cell; germ; tumors; Germ cell tumor; High risk; Chemotherapy; Treatment; Hematology; Stem cell; High dose
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/bmt.2008.364

Germ cell tumors carry an excellent prognosis with platinum-based therapy upfront. The patients who either relapse or demonstrate refractoriness to platinum pose a challenge. There exist many reports in the literature on the use of high-dose chemotherapy and stem cell rescue improving the outcome in patients with relapsed germ cell tumors. However, the reports have great variability in the patient selection, prior treatments, the choice of the conditioning regimen and variability of the doses within the same regimen. In this report, we present 37 patients who underwent a uniform protocol of high-dose chemotherapy with stem cell rescue. Stem cell mobilization was performed with high-dose CY (4 g per m 2 ) and we were able to collect adequate cells for marrow rescue in all patients. Patients received a high-dose regimen with etoposide (800 mg/m 2 per day) days −6, −5 and −4 as a continuous infusion, carboplatin (667 mg/m 2 per day) on days −6, −5 and −4 as a 1 h infusion, and CY (60 mg/kg per day) on days −3 and −2. In this high-risk group of patients, high-dose chemotherapy with autologous stem cell rescue led to a 3-year overall survival of 57% and a 3-year event-free survival of 49%. The results are reflective of a single procedure. No tandem transplants were performed. The treatment-related mortality was low at 3% in this heavily pretreated group.