Salvage therapy with high-dose chemotherapy (HDCT) and peripheral blood stem cell transplant (PBSCT) in patients with primary mediastinal nonseminomatous germ cell tumors (PMNSGCT).

Abstract

e15119 Background: Salvage therapy with high dose chemotherapy (HDCT) and bone marrow transplant (BMT) or peripheral blood stem cell transplant (PBSCT) has curative potential in patients with recurrent germ cell tumor. Patients with primary mediastinal non-seminomatous germ cell tumors (PMNSGCT) have had poor results with any form of salvage chemotherapy including HDCT. From 1986 to 1996, we included 13 patients with PMNSGCT in our series treated with HDCT and BMT. All died from progressive cancer. Methods: We switched from BMT to PBSCT in 1996, allowing more rapid engraftment and earlier initiation of the second course of HDCT with tandem transplant. 116 of 184 (63%) patients with recurrent or refractory germ cell tumors treated from 1996 to 2004 were alive and continuously disease free (NEJM 357:340-348, 2007). PMNSGCT patients were excluded. In 2006, we resumed treating patients with recurrent PMNSGCT with salvage HDCT with PBSCT. Carboplatin 700mg/m2 x 3 plus etoposide 750mgs/m2 x3 were given with second course 3-4 weeks later. Results: 12 patients were treated, 11 as initial salvage chemotherapy and one as 4th line therapy. Eight patients had major thoracic resections prior to HDCT. 3 of the 12 achieved complete remission (52, 12 and 12 weeks duration) but all have relapsed. 10 of the 12 have died; one is lost to follow-up at 44 weeks, and one patient is currently disease free at 176 weeks from HDCT, treated with subsequent salvage surgery. However, he developed secondary acute myeloid leukemia and underwent allogeneic BMT. Median survival for the 12 patients was 41 weeks (range 14-176). Conclusions: In our experience with tandem transplant, recurrent PMNSGCT continues to have a low probability for cure.