title: High-dose chemotherapy for germ cell tumors: do we have a model?
abstract: BACKGROUND
  Since the late nineties, the intensification of chemotherapy doses with hematopoietic stem cell rescue held promise for patients with advanced and poor prognosis germ cell tumors (GCTs). High-dose chemotherapy (HDCT) has, nowadays, a recognized indication in the salvage setting of advanced GCTs and is steadily utilized worldwide.
  
  
  METHODS
  We evaluated the available data with the use of HDCT in these patients. In addition, we provided an original perspective on several issues as experts on behalf of the European Society for Blood and Marrow Transplantation and IGG, including peripheral blood stem cells mobilization and the use of HDCT in special subpopulations of GCT, with the aim to help clarify critical issues in the absence of available clear-cut information.
  
  
  CONCLUSIONS
  Despite HDCT being currently considered a therapeutic option in the salvage setting, critical questions regarding patient selection are still unanswered. Eligibility of patients with a chemoresistant disease, the use of available prognostic factors as well as tumor marker decline in clinical practice are pending issues. Moving forward, these are critical arguments in favor of further clinical research in the field of advanced GCTs.
authors.affiliation: Fondazione IRCCS Istituto Nazionale dei Tumori, Department of Medical Oncology, Medical Oncology 2 Unit , Via G. Venezian 1, 20133 Milano , Italy +39 02 2390 2402 ; +39 02 2390 3150 ; andrea.necchi@istitutotumori.mi.it.
authors.forename: Andrea
authors.initials: A
authors.lastname: Necchi
authors.forename: Francesco
authors.initials: F
authors.lastname: Lanza
authors.forename: Giovanni
authors.initials: G
authors.lastname: Rosti
authors.forename: Massimo
authors.initials: M
authors.lastname: Martino
authors.forename: Elena
authors.initials: E
authors.lastname: Farè
authors.forename: Paolo
authors.initials: P
authors.lastname: Pedrazzoli
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D016026:Bone Marrow Transplantation; D004305:Dose-Response Relationship, Drug; D018380:Hematopoietic Stem Cell Transplantation; D006412:Hematopoietic Stem Cells; D006801:Humans; D008297:Male; D008954:Models, Biological; D009373:Neoplasms, Germ Cell and Embryonal / Q000175:diagnosis* / Q000188:drug therapy* / Q000473:pathology; D011379:Prognosis; D016879:Salvage Therapy; D013736:Testicular Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology
keywords: chemosensitivity; germ cell and embryonal; high-dose chemotherapy; neoplasms; peripheral blood stem cells mobilization; prognostic factors; salvage therapy; testicular cancer; transplantation