Individual Treatment with Stem Cell Rescue in Patients with Germ-Cell Tumors. Results of One Centrum.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 5429-5429
Author(s):  
Jana Nepomucka ◽  
Jitka Abrahamova ◽  
Martin Foldyna ◽  
Zuzana Donatova ◽  
Drahomira Kordikova ◽  
...  
Keyword(s):  
Stem Cell ◽  
Germ Cell ◽  
Germ Cell Tumors ◽  
High Dose Chemotherapy ◽  
Salvage Treatment ◽  
Individual Treatment ◽  
High Dose ◽  
Line Treatment ◽  
Stem Cell Rescue ◽  
The Individual

Abstract Background: Treatment with high dose chemotherapy and autologous stem cell rescue in pacients with poor risk germ cell tumors is still controversial. Results of multicentric randomized EBMT study IT 94 presented at ASCO 2002 show benefit in 1-year EFS in high dose arm (52% versus 48%), 3-year EFS was the same in both arms (53%) in salvage treatment. Individual treatment with stem cell rescue as upfront treatment offers a survival benefit. Methods:Autologous stem cell rescue was provided in our center, from September 1997 to May 2006 to 52 patients. High dose chemotherapy was indicated to 32 patients in salvage setting after 2nd line of treatment (VeIP) and to 20 patients as upfront treatment after 1st line treatment (BEP). Median age was 29 years and tumor markers were elevated: HCG in 9 pts, AFP in 13 pts. Stem cell mobilization was performed after the 3rd cycle of VeIP or BEP in combination with G-CSF. The amount of CD34+ cell/kg b.w. was between 2,0 – 13.4×106. High - dose conditioning regimen CARBOPEC (carboplatin 1600 – 2 200 mg/m2, etoposide 1 800mg/m2, cyclophosphamide 6 400 mg/m2) was used. The treatment was well tolerated without transplant - related mortality. Results: WHO criteria non - hematological toxicity was predominantly grade 2 to 3. Engraftment was rapid, recovery of hematopoiesis in neutrofils over 1.0×109/l and platelets over 50×109/l was reached an average on days +10 and +13 respectively. Additional post-transplant treatment for persistence, progression or relaps had 20 patients (8pts had 2nd line treatment VEIP, 12pts had 3nd line treatment with paclitaxel+gemcitabine and 5 pts had retroperitoneal lymfadenectomy). The follow - up period ranges from 3 to 99 months, at present 38 (73 %) patients are alive, 14 (27 %) pts died. Median TTP of all pts is 10 months, median OS of all pts is 39 months. Median DFS of surviving pts is 38 months. Conclusion: high-dose chemotherapy with autologous stem cell rescue in patients with poor risk germ cell tumors is feasible and beneficial method of the individual treatment. High-dose chemotherapy as upfront treatment for poor prognosis germ cell tumors and as salvage treatment in good risk pts seems to be good possibility of the individual treatment.

High-Dose Chemotherapy and Stem-Cell Rescue for Metastatic Germ-Cell Tumors

2007 ◽  
Vol 357 (4) ◽  
pp. 340-348 ◽  
Author(s):  
Lawrence H. Einhorn ◽  
Stephen D. Williams ◽  
Amy Chamness ◽  
Mary J. Brames ◽  
Susan M. Perkins ◽  
...  
Keyword(s):  
Stem Cell ◽  
Germ Cell ◽  
Germ Cell Tumors ◽  
High Dose Chemotherapy ◽  
High Dose ◽  
Stem Cell Rescue

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

2008 ◽  
Vol 43 (7) ◽  
pp. 547-552 ◽  
Author(s):  
R Agarwal ◽  
C C Dvorak ◽  
K E Stockerl-Goldstein ◽  
L Johnston ◽  
S Srinivas
Keyword(s):  
Stem Cell ◽  
High Risk ◽  
Germ Cell ◽  
Germ Cell Tumors ◽  
High Dose Chemotherapy ◽  
High Dose ◽  
Stem Cell Rescue

Thiotepa-Based High-Dose Chemotherapy With Autologous Stem-Cell Rescue in Patients With Recurrent or Progressive CNS Germ Cell Tumors

2004 ◽  
Vol 22 (10) ◽  
pp. 1934-1943 ◽  
Author(s):  
Shakeel Modak ◽  
Sharon Gardner ◽  
Ira J. Dunkel ◽  
Casilda Balmaceda ◽  
Marc K. Rosenblum ◽  
...  
Keyword(s):  
Stem Cell ◽  
Germ Cell ◽  
Median Survival ◽  
Germ Cell Tumors ◽  
Complete Response ◽  
High Dose Chemotherapy ◽  
Entire Group ◽  
High Dose ◽  
Stem Cell Rescue ◽  
Autologous Stem Cell Rescue

Purpose To evaluate the efficacy and toxicity of high-dose chemotherapy (HDC) followed by autologous stem-cell rescue (ASCR) in patients with relapsed or progressive CNS germ cell tumors (GCTs). Patients and Methods Twenty-one patients with CNS GCTs who experienced relapse or progression despite having received initial chemotherapy and/or radiotherapy were treated with thiotepa-based HDC regimens followed by ASCR. Results Estimated overall survival (OS) and event-free survival (EFS) rates for the entire group 4 years after HDC were 57% ± 12% and 52% ± 14%, respectively. Seven of nine (78%) patients with germinoma survived disease-free after HDC with a median survival of 48 months. One patient died as a result of progressive disease (PD) 39 months after HDC, and another died as a result of pulmonary fibrosis unrelated to HDC 78 months after ASCR without assessable disease. However, only four of 12 patients (33%) with nongerminomatous germ cell tumors (NGGCTs) survived without evidence of disease, with a median survival of 35 months. Eight patients with NGGCTs died as a result of PD, with a median survival of 4 months after HDC (range, 2 to 17 months). Patients with germinoma fared better than those with NGGCTs (P = .016 and .014 for OS and EFS, respectively). Patients with complete response to HDC also had significantly better outcome (P < .001 for OS and EFS) compared with patients with only a partial response or stable disease. There were no toxic deaths because of HDC. Conclusion Dose escalation of chemotherapy followed by ASCR is effective therapy for patients with recurrent CNS germinomas and might be effective in patients with recurrent NGGCTs with a low tumor burden.

scholarly journals High-Dose Chemotherapy with Autologous Hematopoietic Stem-Cell Rescue for Pediatric Brain Tumor Patients: A Single Institution Experience from UCLA

2011 ◽  
Vol 2011 ◽  
pp. 1-11 ◽  
Author(s):  
Eduard H. Panosyan ◽  
Alan K. Ikeda ◽  
Vivian Y. Chang ◽  
Dan R. Laks ◽  
Charles L. Reeb ◽  
...  
Keyword(s):  
Stem Cell ◽  
Brain Tumors ◽  
Hematopoietic Stem Cell ◽  
Germ Cell Tumors ◽  
Pediatric Brain Tumors ◽  
High Dose Chemotherapy ◽  
High Dose ◽  
Hematopoietic Stem ◽  
Stem Cell Rescue ◽  
Pediatric Brain

Background. Dose-dependent response makes certain pediatric brain tumors appropriate targets for high-dose chemotherapy with autologous hematopoietic stem-cell rescue (HDCT-AHSCR).Methods. The clinical outcomes and toxicities were analyzed retrospectively for 18 consecutive patients ≤19 y/o treated with HDCT-AHSCR at UCLA (1999–2009).Results. Patients' median age was 2.3 years. Fourteen had primary and 4 recurrent tumors: 12 neural/embryonal (7 medulloblastomas, 4 primitive neuroectodermal tumors, and a pineoblastoma), 3 glial/mixed, and 3 germ cell tumors. Eight patients had initial gross-total and seven subtotal resections. HDCT mostly consisted of carboplatin and/or thiotepa ± etoposide (n=16). Nine patients underwent a single AHSCR and nine ≥3 tandems. Three-year progression-free and overall survival probabilities were 60.5% ± 16 and 69.3% ± 11.5. Ten patients with pre-AHSCR complete remissions were alive/disease-free, whereas 5 of 8 with measurable disease were deceased (median followup: 2.3 yrs). Nine of 13 survivors avoided radiation. Single AHSCR regimens had greater toxicity than ≥3 AHSCR (P<.01).Conclusion. HDCT-AHSCR has a definitive, though limited role for selected pediatric brain tumors with poor prognosis and pretransplant complete/partial remissions.

Salvage Treatment With Paclitaxel, Ifosfamide, and Cisplatin Plus High-Dose Carboplatin, Etoposide, and Thiotepa Followed by Autologous Stem-Cell Rescue in Patients With Relapsed or Refractory Germ Cell Cancer

2001 ◽  
Vol 19 (1) ◽  
pp. 81-88 ◽  
Author(s):  
O. Rick ◽  
C. Bokemeyer ◽  
J. Beyer ◽  
J. T. Hartmann ◽  
N. Schwella ◽  
...  
Keyword(s):  
Stem Cell ◽  
Germ Cell ◽  
Tumor Progression ◽  
Stable Disease ◽  
Multiorgan Failure ◽  
Cell Cancer ◽  
Germ Cell Tumors ◽  
Salvage Treatment ◽  
High Dose ◽  
Salvage Regimen

PURPOSE: To study feasibility and efficacy of a new salvage regimen in patients with relapsed and/or refractory germ cell tumors. PATIENTS AND METHODS: Between May 1995 and February 1997, 80 patients were entered onto a phase II study. Conventional-dose salvage treatment with three cycles of paclitaxel 175 mg/m2, ifosfamide 5 × 1.2 g/m2, and cisplatin 5 × 20 mg/m2 (TIP) was followed by one cycle of high-dose chemotherapy (HDCT) with carboplatin 500 mg/m2 × 3, etoposide 600 mg/m2 × 4, and thiotepa 150 to 250 mg/m2 × 3 (CET). In 23 patients, one additional cycle of paclitaxel 175 mg/m2 and ifosfamide 5 g/m2 (TI) was given immediately before TIP to improve stem-cell mobilization. RESULTS: Fifty-five (69%) of 80 patients responded to TIP, 24 (30%) of 80 patients had stable disease (n = 5) or tumor progression (n = 19), and one patient died. Only 62 (78%) of 80 patients received subsequent HDCT. Among those, 41 (66%) of 62 patients responded and 20 (32%) of 62 patients had stable disease (n = 3) or tumor progression (n = 17). One patient died after HDCT from multiorgan failure. Survival probabilities at 3 years were 30% for overall and 25% for event-free survival. Peripheral neurotoxicity with sensorimotor impairment grade 2 through 4 in 29%, paresthesias grade 2 through 4 in 24%, and skin toxicity grade 2 through 3 in 15% of patients were the most relevant side effects. CONCLUSION: Treatment with TIP followed by high-dose CET is feasible and can induce long-term remissions in 25% of patients with relapsed or refractory germ cell tumors. Peripheral nervous toxicity in approximately one third of patients is a disadvantage of this salvage strategy.

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