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Detection of secondary malignancy following high-dose chemotherapy in germ cell tumors: prospects and limitations

Bone Marrow Transplantation volume 53, pages 661–663 (2018)Cite this article

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Patients with germ cell tumors (GCT) progressing after first line platinum based therapy can be potentially cured with high-dose chemotherapy followed boy hematopoietic stem cell rescue (HDCT). This can be given in the form of tandem or triple courses of carboplatin and etoposide with encouraging survival rates [1]. Although there is an ongoing debate among experts whether HDCT should be the standard of care in these patients, it remains a widely employed practice [2]. Not surprisingly, given the curative potential of HDCT in GCT, secondary malignancies (SM) have been observed as a well-recognized late effect post transplant.

In this issue of Bone Marrow Transplantation, Necchi et al. [3] reported from the European Society for Blood and Marrow Transplantation (EBMT) registry, the incidence of SM following HDCT for GCT. The study included patients over 18 years of age with gonadal or extra-gonadal primary tumor origin. The primary objective was the cumulative incidence (CI) and associated risk factors for development of SM in an impressive cohort of 5218 patients treated over 3 decades and a median follow up of 3.8 years. During this time, they observed a total of 59 cases of SM, 23 of hematologic origin and 34 solid malignancies (2 additional unclassified SM cases) with corresponding time to event of 39 and 62 months, respectively. Importantly, pre-HDCT therapy including utilization of radiotherapy was not available for most patients. About half the patients received carboplatin and etoposide. Collectively, the CI of solid and hematologic malignancy at 20 years was 4.17 and 1.37%, respectively. Age over 40 years was significantly associated with the development of hematologic malignancies. Overall survival was significantly worse for patients developing hematologic malignancies, with a median of 8.6 months vs. 34.4 months.

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Authors and Affiliations

  1. Division of Hematology & HSCT, Department of Oncology, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City Riyadh, Riyadh, Saudi Arabia

    Moussab Damlaj

  2. Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA

    Shahrukh K. Hashmi

  3. Oncology Center, King Faisal Hospital Specialist Hospital and Research Center, Riyadh, Saudi Arabia

    Shahrukh K. Hashmi

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  1. Moussab Damlaj
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Correspondence to Shahrukh K. Hashmi.

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Damlaj, M., Hashmi, S.K. Detection of secondary malignancy following high-dose chemotherapy in germ cell tumors: prospects and limitations. Bone Marrow Transplant 53, 661–663 (2018). https://doi.org/10.1038/s41409-018-0101-0

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