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.

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

Intravascular Lymphoma: Poor Outcomes May Be Improved with Aggressive Therapy.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 938-938 ◽  
Author(s):  
Christopher A. Yasenchak ◽  
Ahmet Dogan ◽  
Joseph P. Colgan ◽  
Thomas M. Habermann ◽  
David J. Inwards ◽  
...  
Keyword(s):  
Stem Cell ◽  
Median Survival ◽  
Peripheral Blood ◽  
High Dose Chemotherapy ◽  
Organ Involvement ◽  
High Dose ◽  
Intravascular Lymphoma ◽  
Stem Cell Rescue ◽  
Autologous Stem Cell Rescue

Abstract Intravascular lymphoma is a rare subtype of extranodal DLBCL characterized by the proliferation of malignant B-cells within the lumina of blood vessels. Organ involvement is variable and diffuse. Making the diagnosis can be challenging with symptoms persisting for months prior to definitive diagnosis. Treatment to date with standard anthracycline containing chemotherapy regimens has been disappointing with variable response rates, high relapse rates, and median survival times typically measured in months. We report diagnostic, treatment, and follow-up information regarding a group of patients with intravascular lymphoma evaluated at the Mayo Clinic with special attention to those receiving rituximab and/or high dose chemotherapy with or without peripheral blood autologous stem cell rescue. Methods: The medical records of patients with intravascular lymphoma seen at the Mayo Clinic between January 1970 and May 2005 were reviewed. Patients were included if they had evidence of intravascular lymphoma at the time of diagnosis of lymphoma. Pathologic specimens were reviewed for confirmation of diagnosis. Results: Twenty patients with a diagnosis of intravascular lymphoma were identified. Their median age was 66.5 years. Thirteen (65%) had B symptoms at the time of diagnosis and 13 had a performance status ≥ 3. Nine (45%) had an IPI ≥ 4. The median time to diagnosis from the onset of symptoms was 5.5 months. All had stage IV disease with biopsy proven involvement of at least one organ. The sites of disease involvement were CNS (10), marrow (7), lung (5), adrenal (3), kidney (2), lymph node, seminal vesicle, and skin (1). Two patients had involvement of three organs, six had involvement of two organs, and twelve had involvement of one organ. Nineteen patients received chemotherapy: ProMACE/CytaBOM (3), CHOP (6), RCHOP (6), DHAP (1), high dose methotrexate (1), methylprednisolone, nitrogen mustard, rituximab (1), and hyperCVAD (1). Three patients underwent peripheral blood autologous stem cell rescue after conditioning with BEAM. With a median follow-up of 60 months for all patients, the median overall survival was 8 months. No difference in outcome was seen with regard to site of organ involvement, number of organs involved, presence of B symptoms, or IPI. With a median follow-up for those receiving rituximab of 26 months, the median survival has not yet been reached while the median survival for those receiving non-rituximab containing regimens was 6.5 months. Similarly, with a median follow-up for those receiving high dose chemotherapy (hyperCVAD or BEAM) of 9.3 months, the median survival has not yet been reached while the median survival for those not receiving high dose therapy was 7 months. Conclusion: Intravascular lymphoma is a unique and aggressive subtype of DLBCL. The clinical presentation and sites of organ involvement are variable and the time from onset of symptoms to diagnosis can be prolonged. Standard chemotherapeutic treatment leads to poor outcomes. However, survival may be improved upon with newer strategies such as the use of rituximab and/or high dose chemotherapy with or without peripheral blood autologous stem cell rescue.

High-dose chemotherapy with autologous stem-cell rescue in patients with recurrent and high-risk pediatric brain tumors.

1997 ◽  
Vol 15 (5) ◽  
pp. 1814-1823 ◽  
Author(s):  
M L Graham ◽  
J E Herndon ◽  
J R Casey ◽  
S Chaffee ◽  
G H Ciocci ◽  
...  
Keyword(s):  
Stem Cell ◽  
High Risk ◽  
Germ Cell Tumors ◽  
Pediatric Brain Tumors ◽  
High Dose Chemotherapy ◽  
High Dose ◽  
Disease Response ◽  
Stem Cell Rescue ◽  
Autologous Stem Cell Rescue ◽  
Cns Malignancies

PURPOSE We treated 49 patients with recurrent or poor-prognosis CNS malignancies with high-dose chemotherapy regimens followed by autologous marrow rescue with or without peripheral-blood stem-cell augmentation to determine the toxicity of and event-free survival after these regimens. PATIENTS AND METHODS Nineteen patients had medulloblastomas, 12 had glial tumors, seven had pineoblastomas, five had ependymomas, three had primitive neuroectodermal tumors, two had germ cell tumors, and one had fibrosarcoma. Thirty-seven received chemotherapy with cyclophosphamide 1.5 g/m2 daily x 4 and melphalan 25 to 60 mg/m2 daily x 3. Nine received busulfan 37.5 mg/m2 every 6 hours x 16 and melphalan 180 mg/m2 (n = 7) or 140 mg/m2 (n = 2). Three received carboplatin 700 mg/m2/d on days -7, -5, and -3 and etoposide 500 mg/m2/d on days -6, -4, and -2. All patients received standard supportive care. RESULTS Eighteen of 49 patients survive event-free 22+ to 55+ months (median, 33+) after transplantation, including nine of 16 treated before recurrence and nine of 33 treated after recurrence. There was one transplant-related death from pulmonary aspergillosis. Of five patients assessable for disease response, one had a partial remission (2 months), one has had stable disease (55+ months), and three showed progression 2, 5, and 8 months after transplantation. CONCLUSION The toxicity of these regimens was tolerable. Certain patients with high-risk CNS malignancies may benefit from such a treatment approach. Subsequent trials should attempt to determine which patients are most likely to benefit from high-dose chemotherapy with autologous stem-cell rescue.

scholarly journals Paclitaxel-Based High-Dose Chemotherapy with Autologous Stem Cell Rescue for Relapsed Germ Cell Cancer

2005 ◽  
Vol 11 (11) ◽  
pp. 903-911 ◽  
Author(s):  
Kim A. Margolin ◽  
James H. Doroshow ◽  
Paul Frankel ◽  
Warren Chow ◽  
Lucille A. Leong ◽  
...  
Keyword(s):  
Stem Cell ◽  
Germ Cell ◽  
Cell Cancer ◽  
High Dose Chemotherapy ◽  
Germ Cell Cancer ◽  
High Dose ◽  
Stem Cell Rescue ◽  
Autologous Stem Cell Rescue

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.

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