title: High-dose chemotherapy (HDCT) as second-salvage treatment in patients with multiple relapsed or refractory germ-cell tumors.
abstract: BACKGROUND
  Survival after high-dose chemotherapy (HDCT) as second-salvage treatment (SST) in multiple relapsed germ-cell tumors (GCTs).
  
  
  METHODS
  Existing databases in Berlin and Marburg of HDCT trials from 1989 to 2008 were retrospectively screened. Among 534 patients, 71 of 534 (13%) patients were scheduled for HDCT having failed previous conventional-dose first-line and first-salvage chemotherapy regimens; those 49 patients who had received at least cisplatin plus etoposide first-line as well as conventional-dose cisplatin-based first-salvage regimens and were diagnosed after 1 January 1990 were further analyzed.
  
  
  RESULTS
  Median age at SST was 32 years (range 19-52 years). Median follow-up for surviving patients was 4 years (range 1.7-8.5 years). Three of 49 (6%) patients either progressed or died before scheduled HDCT; the remaining 46 of 49 (94%) received either single or sequential HDCT. The rate of favorable responses to HDCT was 27 of 49 (55%). Nine patients remain alive and free of progression. One additional patient was lost to follow without progression at 4 years. The projected overall survival rate at 5 years was 17% (95% confidence intervals 7% to 30%).
  
  
  CONCLUSIONS
  HDCT can induce remissions in patients with multiple relapsed GCTs with a long-term survival rate of approximately 17%.
authors.affiliation: Departments of Hematology and Oncology, Universitätsklinikum Giessen und Marburg GmbH, Marburg.
authors.forename: A
authors.initials: A
authors.lastname: Lorch
authors.affiliation: Departments of Hematology and Oncology, Universitätsklinikum Giessen und Marburg GmbH, Marburg.
authors.forename: A
authors.initials: A
authors.lastname: Neubauer
authors.affiliation: Departments of Hematology and Oncology, Vivantes Klinikum Am Urban, Berlin.
authors.forename: M
authors.initials: M
authors.lastname: Hackenthal
authors.affiliation: Departments of Hematology and Oncology, Charite Campus Mitte, Berlin.
authors.forename: A
authors.initials: A
authors.lastname: Dieing
authors.affiliation: Departments of Hematology and Oncology, South West German Comprehensive Cancer Center, Tübingen.
authors.forename: J T
authors.initials: JT
authors.lastname: Hartmann
authors.affiliation: Departments of Hematology and Oncology, Klinik Reinhardshöhe, Bad Wildungen.
authors.forename: O
authors.initials: O
authors.lastname: Rick
authors.affiliation: Departments of Oncology, Hematology and BMT with section Pneumology, Hubertus Wald Tumorzentrum - UCCH University Medical Center Hamburg Eppendorf, Hamburg, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Bokemeyer
authors.affiliation: Departments of Hematology and Oncology, Vivantes Klinikum Am Urban, Berlin. Electronic address: joerg.beyer@vivantes.de.
authors.forename: J
authors.initials: J
authors.lastname: Beyer
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D002945:Cisplatin / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D019008:Drug Resistance, Neoplasm / Q000187:drug effects; D005047:Etoposide / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy* / Q000401:mortality; D012008:Recurrence; D012189:Retrospective Studies; D016879:Salvage Therapy; D016019:Survival Analysis; D013736:Testicular Neoplasms / Q000188:drug therapy* / Q000401:mortality; D017211:Treatment Failure; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005047:Etoposide; D002945:Cisplatin