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Administration of high-dose chemotherapy with stem cell support in patients 40 years of age or older with advanced germ cell tumours: a retrospective study from the European Society for Blood and Marrow Transplantation database

Bone Marrow Transplantation volume 52, pages 1218–1220 (2017)Cite this article

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Germ cell tumours (GCT) comprise exquisitely chemosensitive neoplasms, and cure is possible in patients presenting with a high metastatic tumour burden. For the few patients with high-risk disease or who relapse after first-line chemotherapy, the administration of a tandem or a triple course of high-dose chemotherapy (HDCT) with carboplatin and etoposide with stem cell support may represent a valuable therapeutic option.1, 2, 3 Although GCT remains the most frequent solid tumour in young adults, evidence of a shift towards older age at diagnosis has been reported by many authors.4 Furthermore, increasing age at diagnosis has been reported to have a poor prognostic effect in GCT patients receiving first-line chemotherapy.5, 6, 7 In a large study by Danish authors and another double-institution dataset, age was identified as a statistically significant poor prognostic factor in multivariable analyses. For this reason, it is possible that older patients with GCT have an inherently negative prognostic factor related to their age, which may partly explain the inability to administer timely curative chemotherapy in some cases due to the haematological toxicity of bleomycin, etoposide, and cisplatin (BEP) chemotherapy.8, 9, 10, 11, 12

In general, for patients aged 40 years or older, there are concerns regarding the possibility of administering standard chemotherapy in a timely manner and preserving the full dose of all drugs throughout the treatment course. In the case of HDCT administration, limited data are available for older GCT patients, and the benchmark safety data can be transferred from haematologic neoplasms. Obtaining robust information that HDCT can be safely administered in this patient population may help clinicians in the decision-making process and patient counselling, given the uncertainties regarding the optimal salvage therapeutic strategy.

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Authors and Affiliations

  1. Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy

    A Necchi, S Lo Vullo, P Giannatempo, D Raggi & L Mariani

  2. Fondazione IRCCS Policlinico San Matteo, Pavia, Italy

    G Rosti, S Secondino & P Pedrazzoli

  3. EBMT Study Office, EBMT, Paris, France

    M Badoglio

  4. Hospital of Ravenna, Ravenna, Italy

    F Lanza

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  1. A Necchi
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on behalf of the European Society for Blood and Marrow Transplantation, Solid Tumors Working Party (EBMT-STWP)

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Correspondence to A Necchi.

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The authors declare no conflict of interest.

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Presented in a poster session, 2017 Genitourinary Cancers Symposium, 16–18 February 2017, Orlando, FL, USA. Presented in an oral session, 43rd Annual Meeting of the European Society for Blood and Marrow Transplantation (EBMT), 26–29 March 2017, Marseille, France.

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Necchi, A., Lo Vullo, S., Rosti, G. et al. Administration of high-dose chemotherapy with stem cell support in patients 40 years of age or older with advanced germ cell tumours: a retrospective study from the European Society for Blood and Marrow Transplantation database. Bone Marrow Transplant 52, 1218–1220 (2017). https://doi.org/10.1038/bmt.2017.106

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