The status of high-dose chemotherapy with hematopoietic stem cell transplantation in germ cell tumor patients.
OBJECTIVE
Germ cell tumors (GCTs) are very chemosensitive cancers, in which high-dose chemotherapy (HDCT) has been investigated as salvage therapy or as first-line treatment in poor prognosis patients. This paper presents an update of available information in order to define the status of HDCT in GCT patients.


METHODS
The authors have been working in this field, contributing to international clinical trials and to peer-reviewed journals with original papers. The material examined in this review includes articles published in journals covered by MedLine, reviews from journals with high impact factor, and unpublished data from the European Group for Blood and Marrow Transplantation (EBMT) registry.


CONCLUSIONS
The delineation of prognostic factors associated with a poor probability of survival after HDCT contributed to the selection of patients who are likely to get an advantage from HDCT and those who should be spared from dose-intensive treatment. HDCT as first-line therapy for poor prognosis GCT (IGCCCG classification), and in a salvage setting in good risk GCT (prognostic index from Beyer et al.77), has been associated with a very high rate of complete remissions and long-term disease-free survivors. However, it is important to wait for the results of ongoing randomized trials for the validation of these findings. Other strategies are required for patients with refractory GCTs. Several new treatment options are currently emerging for this subset of patients.
De Giorgi
Ugo
U
Department of Oncology and Hematology, Santa Maria delle Croci Hospital, viale Randi 5, 48100 Ravenna, Italy. ugo.degiorgi@ra.nettuno.it
Rosti
Giovanni
G
Papiani
Giorgio
G
Marangolo
Maurizio
M
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001761:Bleomycin / Q000008:administration & dosage; D016190:Carboplatin / Q000008:administration & dosage; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D017321:Clinical Trials, Phase I as Topic; D017322:Clinical Trials, Phase II as Topic; D003520:Cyclophosphamide / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005060:Europe / Q000453:epidemiology; D005544:Forecasting; D005767:Gastrointestinal Diseases / Q000209:etiology; D018237:Germinoma / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D006402:Hematologic Diseases / Q000209:etiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006504:Hepatic Veno-Occlusive Disease / Q000209:etiology; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D007674:Kidney Diseases / Q000139:chemically induced; D008297:Male; D015337:Multicenter Studies as Topic; D016609:Neoplasms, Second Primary / Q000453:epidemiology / Q000209:etiology; D017239:Paclitaxel / Q000008:administration & dosage; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D016879:Salvage Therapy; D013852:Thiotepa / Q000008:administration & dosage; D019172:Transplantation Conditioning / Q000009:adverse effects; D014182:Transplantation, Autologous; D016896:Treatment Outcome
D001761:Bleomycin; D005047:Etoposide; D003520:Cyclophosphamide; D013852:Thiotepa; D016190:Carboplatin; D017239:Paclitaxel; D002945:Cisplatin; D007069:Ifosfamide