title: Long-term outcome of salvage high-dose chemotherapy in patients with germ cell tumor with poor prognostic features.
abstract: OBJECTIVE
  High-dose chemotherapy (HDCT) represents an option as salvage treatment for patients with resistant/refractory germ cell tumor (GCT). The objective of this retrospective analysis was to evaluate the long-term results of a single-center experience with salvage HDCT for GCT patients, and to validate the prognostic model proposed by Einhorn and colleagues [9].
  
  
  METHODS
  Between 1986 and 2003, 100 GCT patients received salvage HDCT consisting of high-doses of carboplatin, etoposide ± cyclophosphamide, or ifosfamide. Twenty-four patients underwent a second HDCT cycle, and in 1 case, a third cycle was given with a median interval time of 6 weeks (range, 5-10).
  
  
  RESULTS
  With a median follow-up of 8 years (range, 3-17); 6 of 32 (19%) patients with resistant GCT and 1 of 19 (5%) patients with cisplatin-refractory disease have been continuously disease-free, while none of the 16 patients with absolutely cisplatin-refractory GCT were alive at 1 year from HDCT treatment. In the PBPC era, HDCT appeared to be inapplicable in 32% of patients, mainly due to progressive disease during the induction/mobilizing phase. The prognostic model by Einhorn et al. for tandem HDCT did categorize our patients treated with a single HDCT cycle or low-dose intensity regimens in a very similar manner, but with inferior overall results.
  
  
  CONCLUSIONS
  Long-term results with a single HDCT cycle or a low dose-intensity multicycle HDCT regimen remained poor in patients with adverse prognostic features. The tandem HDCT regimen represents a major option for refractory GCTs and relapsed tumors in third-line or later therapy, while a single course of HDCT should be abandoned for these patients.
authors: Department of Oncology and Hematology, Istituto Oncologico Romagnolo-Santa Maria delle Croci Hospital, Ravenna, Italy. ugo_degiorgi@yahoo.com
authors: Ugo
authors: U
authors: De Giorgi
authors: Giovanni
authors: G
authors: Rosti
authors: Roberto
authors: R
authors: Salvioni
authors: Giorgio
authors: G
authors: Papiani
authors: Michela
authors: M
authors: Ballardini
authors: Giorgio
authors: G
authors: Pizzocaro
authors: Maurizio
authors: M
authors: Marangolo
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage; D003520:Cyclophosphamide / Q000008:administration & dosage; D019008:Drug Resistance, Neoplasm; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy*; D011379:Prognosis; D012189:Retrospective Studies; D016879:Salvage Therapy; D015996:Survival Rate; D013997:Time Factors; D055815:Young Adult
chemical_list: D005047:Etoposide; D003520:Cyclophosphamide; D016190:Carboplatin; D007069:Ifosfamide