High‐dose chemotherapy and autologous bone marrow rescue for patients with refractory germ cell tumors: Early intervention is better tolerated Journal Article


Authors: Motzer, R. J.; Gulati, S. C.; Crown, J. P.; Weisen, S.; Doherty, M.; Herr, H.; Fair, W.; Sheinfeld, J.; Sogani, P.; Russo, P.; Bosl, G. J.
Article Title: High‐dose chemotherapy and autologous bone marrow rescue for patients with refractory germ cell tumors: Early intervention is better tolerated
Abstract: Therapy with high‐dose carboplatin plus etoposide‐based chemotherapy plus autologous bone marrow rescue (AUBMR) was administered to 29 patients with advanced germ cell tumors (GCT) refractory to cisplatin‐based chemotherapy. Two groups of patients with refractory disease were treated. Sixteen patients had been identified as “poor risk” at diagnosis and had an inappropriately slow decline of serum tumor markers after two cycles of induction cisplatin‐based therapy (Group A). In addition, 13 patients were treated who had never had a complete response (CR) or had relapses after ifosfamide‐based salvage chemotherapy (Group B). Patients in Group A were treated with high‐dose carboplatin etoposide, and patients in Group B received high‐dose carboplatin, etoposide, and cyclophosphamide. Fifteen of 29 (52%) patients had a CR (9, Group A; 6, Group B). The patients in Group A had fewer hematologic toxic effects, and the median number of days from day 0 to a granulo‐cyte count greater than 0.5/μl was 16 and to a platelet count of more than 50/μl was 15, compared with 22 days and 23 days in Group B, respectively. There were fewer episodes of culture‐positive sepsis in Group A (12%) compared with Group B (26%), and the only treatment‐related death occurred in Group B. Therapy with high‐dose carboplatin plus etoposide‐based chemotherapy plus AUBMR is effective for patients with GCT refractory to regimens of cisplatin with or without ifosfamide. Early use of high‐dose chemotherapy reduces hematologic toxic effects and allows patients to start treatment in a more predictable fashion after cytoreduction, rather than when the disease is progressing rapidly. Copyright © 1992 American Cancer Society
Keywords: adult; clinical article; controlled study; cisplatin; chemotherapy, adjuvant; neurotoxicity; carboplatin; metastasis; bone marrow; etoposide; blood toxicity; stomatitis; antineoplastic combined chemotherapy protocols; ifosfamide; time factors; remission induction; neoplasms, germ cell and embryonal; bone marrow transplantation; germ cell tumor; ototoxicity; human; male; priority journal; article; support, non-u.s. gov't; support, u.s. gov't, p.h.s.
Journal Title: Cancer
Volume: 69
Issue: 2
ISSN: 0008-543X
Publisher: Wiley Blackwell  
Date Published: 1992-01-15
Start Page: 550
End Page: 556
Language: English
DOI: 10.1002/1097-0142(19920115)69:2<550::Aid-cncr2820690245>3.0.Co;2-d
PUBMED: 1309436
PROVIDER: scopus
DOI/URL:
Notes: Article -- Export Date: 30 July 2019 -- Source: Scopus
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Citation Impact
MSK Authors
  1. Paul Russo
    549 Russo
  2. Robert Motzer
    1084 Motzer
  3. Joel Sheinfeld
    242 Sheinfeld
  4. Pramod C Sogani
    72 Sogani
  5. Harry W Herr
    566 Herr
  6. George Bosl
    422 Bosl
  7. William R Fair
    341 Fair
  8. Subhash C. Gulati
    124 Gulati
  9. John Crown
    47 Crown