EARLY SALVAGE THERAPY FOR GERM-CELL CANCER USING HIGH-DOSE CHEMOTHERAPY WITH AUTOLOGOUS BONE-MARROW SUPPORT

Background. Patients with relapsed germ cell cancer (GCT) have a poor prognosis when treated solely with conventional chemotherapy; high dos e chemotherapy with autologous bone marrow rescue (ABMR) has shown cur ative potential in patients with relapsed and refractory GCT. This pro tocol was designed to incorporate high dose therapy with initial salva ge therapy. Methods. Twenty-three patients in the first relapse of GCT received two cycles of conventional dose cisplatin-based therapy (eit her vinblastine, ifosfamide and cisplatin [VeIP] or cisplatin, vinblas tine, and bleomycin) followed by carboplatin (1500-2100 mg/m(2)) and e toposide (1200-2250 mg/m(2)) given in divided doses with ABMR. Results . Eighteen of 23 patients completed protocol therapy including high do se therapy. Five of 23 did not undergo high dose therapy due to: insur ance refusal (1); patient refusal (1); active infection (1); central n ervous system metastasis (1); death on induction therapy (1). Response to two courses of conventional dose induction therapy (N = 23) was co mplete response (CR), 8; partial response (PR), 12; stable disease (SD ), 2; and toxic death, 1. Two of five individuals who did not continue with high dose therapy are alive and progression free after conventio nal salvage therapy and surgery with at least 24 months of follow-up. Outcome after high dose therapy (N = 18) was CR, 9, PR, 6, SD, 1, and PD, 2. Two patients who were in PR after receiving two cycles of conve ntional dose therapy were converted to CR using high dose therapy. The re was only one treatment-related death in this cohort, a septic death during VeIP induction therapy. There were no transplant related death s. Of those patients completing high dose therapy, 7 of 18 (39%) survi ved, progression free with a median follow-up of 26 months, 2 of 18 ar e alive with active disease, and 9 of 18 died of recurrent disease. Co nclusions. Conventional dose induction therapy followed by consolidati on with high dose therapy and ABMR is well tolerated and provides prol onged disease-free survival in some patients with chemosensitive relap sed germ cell cancer.