LONG-TERM RESULTS OF AUTOLOGOUS MARROW TRANSPLANTATION FOR RELAPSED OR REFRACTORY MALE OR FEMALE GERM-CELL TUMORS

Twenty-one patients with relapsed or refractory germ cell tumors were treated with high-dose chemotherapy and marrow transplantation (HDC/BM T) from 1982-1993, Primary sites of disease were testis (17), ovary (t hree), and pineal gland (one), Pathology included dysgerminoma (one), choriocarcinoma with adenocarcinoma (one), seminoma (four), and nonsem inoma or mixed germ cell tumor (15), Nineteen had at least two prior c hemotherapy regimens and eight had cisplatin-refractory disease define d as progression within 4 weeks of a cycle of cisplatin-based chemothe rapy. HDC regimens were mostly combinations of cyclophosphamide with e toposide and cisplatin or carboplatin, There were only two treatment-r elated deaths (aspergillosis and interstitial pneumonitis), Times to e ngraftment of granulocytes (21 +/- 8.3 days) and platelets (32 +/- 20. 2 days) were reasonable with only the last nine patients receiving gro wth factors, At a minimum of 4 years follow-up, eight patients have di ed of disease, six of whom were cisplatin-refractory prior to transpla nt, Eleven patients (52% overall) are alive and continuously free of d isease after 4-10 years including one of three with refractory ovarian germ cell tumor, HDC/BMT provides significant long-term disease-free survival as salvage therapy for both male and female relapsed germ cel l tumor patients who are not refractory to cisplatin.