Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Letter to the Editor
  • Published:

Comparable outcomes following two or three cycles of high-dose chemotherapy and autologous stem cell transplantation for patients with relapsed/refractory germ cell tumors

Bone Marrow Transplantation volume 52, pages 132–134 (2017)Cite this article

Subjects

Germ cell tumors are among the most curable of solid tumors, with long-term durable remissions seen in >80% of good-risk patients and 50–60% of poor-risk patients.1 However, in 20–30% of patients, the tumor persists or recurs after initial treatment and salvage therapies are required. High-dose chemotherapy (HDC) followed by autologous hematopoietic stem cell transplantation (HDC–HSCT) is a potentially curative approach for this previously treated population, with reported long-term post-transplant survival as high as 70%.2 Questions remain regarding the optimal regimen of HDC and the timing of its use. We reviewed our institutional experience with two different sequential HDC regimens for previously treated germ cell tumors to evaluate and compare the outcomes with this salvage approach.

All patients with previously treated germ cell tumors who received HDC–HSCT at Emory University Hospital between 2002 and 2014 were identified from the transplant database. Patients were either diagnosed and treated at our institution with standard induction chemotherapy with subsequent diagnosis of relapsed/refractory disease or specifically referred at time of progression for HDC–HSCT. Baseline data on the initial presentation and treatment of germ cell cancer, the transplant maneuver and post-transplant outcomes were extracted from the institutional transplant database and the individual medical record of each patient. The Emory University Institutional Review Board approved this retrospective analysis and all patients completed the informed consent for inclusion in the database at the time of their transplant.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

References

  1. Feldman DR, Bosl GJ, Sheinfeld J, Motzer RJ . Medical treatment of advanced testicular cancer. JAMA 2008; 299: 672–684.

    Article  CAS  Google Scholar 

  2. Necchi A, Lanza F, Rosti G, Martino M, Fare E, Pedrazzoli P . High-dose chemotherapy for germ cell tumors: do we have a model? Expert Opin Biol Ther 2015; 15: 33–44.

    Article  CAS  Google Scholar 

  3. Einhorn LH, Williams SD, Chamness A, Brames MJ, Perkins SM, Abonour R . High-dose chemotherapy and stem-cell rescue for metastatic germ-cell tumors. N Engl J Med 2007; 357: 340–348.

    Article  CAS  Google Scholar 

  4. Kondagunta GV, Bacik J, Sheinfeld J, Bajorin D, Bains M, Reich L et al. Paclitaxel plus ifosfamide followed by high-dose carboplatin plus etoposide in previously treated germ cell tumors. J Clin Oncol 2007; 25: 85–90.

    Article  CAS  Google Scholar 

  5. International Germ Cell Cancer Collaborative Group. International germ cell consensus classification: a prognostic factor-based staging system for metastatic germ cell cancers. J Clin Oncol 1997; 15: 594–603.

    Article  Google Scholar 

  6. Lorch A, Beyer J, Bascoul-Mollevi C, Kramar A, Einhorn LH, Necchi A et al. Prognostic factors in patients with metastatic germ cell tumors who experienced treatment failure with cisplatin-based first-line chemotherapy. J Clin Oncol 2010; 28: 4906–4911.

    Article  Google Scholar 

  7. Bokemeyer C, Nichols CR, Droz JP, Schmoll HJ, Horwich A, Gerl A et al. Extragonadal germ cell tumors of the mediastinum and retroperitoneum: results from an international analysis. J Clin Oncol 2002; 20: 1864–1873.

    Article  Google Scholar 

  8. De Giorgi U, Rosti G, Slavin S, Yaniv I, Harousseau JL, Ladenstein R et al. Salvage high-dose chemotherapy for children with extragonadal germ-cell tumours. Br J Cancer 2005; 93: 412–417.

    Article  CAS  Google Scholar 

  9. Feldman DR, Sheinfeld J, Bajorin DF, Fischer P, Turkula S, Ishill N et al. TI-CE high-dose chemotherapy for patients with previously treated germ cell tumors: results and prognostic factor analysis. J Clin Oncol 2010; 28: 1706–1713.

    Article  CAS  Google Scholar 

  10. Reddy Ammakkanavar N, Matei D, Abonour R, Einhorn LH . High-dose chemotherapy for recurrent ovarian germ cell tumors. J Clin Oncol 2015; 33: 226–227.

    Article  Google Scholar 

  11. Meisel JL, Woo KM, Sudarsan N, Eng J, Patil S, Jacobsen EP et al. Development of a risk stratification system to guide treatment for female germ cell tumors. Gynecol Oncol 2015; 138: 566–572.

    Article  Google Scholar 

  12. Voss MH, Feldman DR, Motzer RJ . High-dose chemotherapy and stem cell transplantation for advanced testicular cancer. Expert Rev Anticancer Ther 2011; 11: 1091–1103.

    Article  CAS  Google Scholar 

  13. Motzer RJ, Nichols CJ, Margolin KA, Bacik J, Richardson PG, Vogelzang NJ et al. Phase III randomized trial of conventional-dose chemotherapy with or without high-dose chemotherapy and autologous hematopoietic stem-cell rescue as first-line treatment for patients with poor-prognosis metastatic germ cell tumors. J Clin Oncol 2007; 25: 247–256.

    Article  CAS  Google Scholar 

  14. Pico JL, Rosti G, Kramar A, Wandt H, Koza V, Salvioni R et al. A randomised trial of high-dose chemotherapy in the salvage treatment of patients failing first-line platinum chemotherapy for advanced germ cell tumours. Ann Oncol 2005; 16: 1152–1159.

    Article  Google Scholar 

  15. Lorch A, Kollmannsberger C, Hartmann JT, Metzner B, Schmidt-Wolf IG, Berdel WE et al. Single versus sequential high-dose chemotherapy in patients with relapsed or refractory germ cell tumors: a prospective randomized multicenter trial of the German Testicular Cancer Study Group. J Clin Oncol 2007; 25: 2778–2784.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA

    Z DeFilipp, C B Rosand, D A Goldstein, B C Carthon, W B Harris, O Kucuk, Z Al-Kadhimi, J B Cohen, C R Flowers, M J Lechowicz, A K Nooka, J L Kaufman, A A Langston & E K Waller

  2. Department of Urology, Emory University School of Medicine, Atlanta, GA, USA

    V A Master

  3. Department of Biostatistics and Bioinformatics, Emory University School of Public Health, Atlanta, GA, USA

    Z Chen & J Arora

Authors
  1. Z DeFilipp
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C B Rosand
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. D A Goldstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. V A Master
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. B C Carthon
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. W B Harris
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. O Kucuk
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Z Al-Kadhimi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. J B Cohen
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. C R Flowers
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. M J Lechowicz
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. A K Nooka
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. J L Kaufman
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. A A Langston
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Z Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. J Arora
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. E K Waller
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to E K Waller.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

DeFilipp, Z., Rosand, C., Goldstein, D. et al. Comparable outcomes following two or three cycles of high-dose chemotherapy and autologous stem cell transplantation for patients with relapsed/refractory germ cell tumors. Bone Marrow Transplant 52, 132–134 (2017). https://doi.org/10.1038/bmt.2016.189

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/bmt.2016.189

Search

Advanced search

Quick links