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

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 (4g per m²) and we were able to collect adequate cells for marrow rescue in all patients. Patients received a high-dose regimen with etoposide (800mg/m² per day) days -6, -5 and -4 as a continuous infusion, carboplatin (667mg/m² per day) on days -6, -5 and -4 as a 1h infusion, and CY (60mg/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.