High-dose chemotherapy and stem-cell rescue for metastatic germ-cell tumors

Lawrence Einhorn, Stephen D. Williams, Amy Chamness, Mary J. Brames, Susan Perkins, Rafat Abonour

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: Metastatic testicular tumors that have not been successfully treated by means of initial chemotherapy are potentially curable with salvage chemotherapy. METHODS: We conducted a retrospective review of 184 consecutive patients with metastatic testicular cancer that had progressed after they received cisplatin-containing combination chemotherapy. We gave 173 patients two consecutive courses of high-dose chemotherapy consisting of 700 mg of carboplatin per square meter of body-surface area and 750 mg of etoposide per square meter, each for 3 consecutive days, and each followed by an infusion of autologous peripheral-blood hematopoietic stem cells; the other 11 patients received a single course of this treatment. In 110 patients, cytoreduction with one or two courses of vinblastine plus ifosfamide plus cisplatin preceded the high-dose chemotherapy. RESULTS: Of the 184 patients, 116 had complete remission of disease without relapse during a median follow-up of 48 months (range, 14 to 118). Of the 135 patients who received the treatment as second-line therapy, 94 were disease-free during follow-up; 22 of 49 patients who received treatment as third-line or later therapy were disease-free. Of 40 patients with cancer that was refractory to standard-dose platinum, 18 were disease-free. A total of 98 of 144 patients who had platinum-sensitive disease were disease-free, and 26 of 35 patients with seminoma and 90 of 149 patients with nonseminomatous germ-cell tumors were disease-free. Among the 184 patients, there were three drug-related deaths during therapy. Acute leukemia developed in three additional patients after therapy. CONCLUSIONS: Testicular tumors are potentially curable by means of high-dose chemotherapy plus hematopoietic stem-cell rescue, even when this regimen is used as third-line or later therapy or in patients with platinum-refractory disease.

Original languageEnglish
Pages (from-to)340-348
Number of pages9
JournalNew England Journal of Medicine
Volume357
Issue number4
DOIs
StatePublished - Jul 26 2007

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Germ Cell and Embryonal Neoplasms
Stem Cells
Drug Therapy
Testicular Neoplasms
Platinum
Therapeutics
Hematopoietic Stem Cells
Cisplatin
Ifosfamide
Seminoma
Vinblastine
Body Surface Area
Carboplatin
Etoposide
Combination Drug Therapy
Leukemia

ASJC Scopus subject areas

  • Medicine(all)

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High-dose chemotherapy and stem-cell rescue for metastatic germ-cell tumors. / Einhorn, Lawrence; Williams, Stephen D.; Chamness, Amy; Brames, Mary J.; Perkins, Susan; Abonour, Rafat.

In: New England Journal of Medicine, Vol. 357, No. 4, 26.07.2007, p. 340-348.

Research output: Contribution to journalArticle

Einhorn, Lawrence ; Williams, Stephen D. ; Chamness, Amy ; Brames, Mary J. ; Perkins, Susan ; Abonour, Rafat. / High-dose chemotherapy and stem-cell rescue for metastatic germ-cell tumors. In: New England Journal of Medicine. 2007 ; Vol. 357, No. 4. pp. 340-348.
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