High-dose chemotherapy and stem-cell rescue for metastatic germ-cell tumors: Einhorn LH, Williams SD, Chamness A, Brames MJ, Perkins SM, Abonour R, Division of Hematology-Oncology, Indiana University School of Medicine, Indianapolis, IN

Background atic testicular tumors that have not been successfully treated by means of initial chemotherapy are potentially curable with salvage chemotherapy. s ducted 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 2 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 1 or 2 courses of vinblastine plus ifosfamide plus cisplatin preceded the high-dose chemotherapy. s 184 patients, 116 had complete remission of disease without relapse during a median follow-up of 48 months (range, 14–118). 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 who were 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 3 drug-related deaths during therapy. Acute leukemia developed in three additional patients after therapy. sions ular 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.