Individual treatment of germ cell tumours including autologous stem cell transplantation

Overview

The treatment of germ cell tumours follows standard recommended treatment guidelines (European Association of Urology Guidelines 2007). The contribution of high-dose chemotherapy with autologous stem cell transplantation is still controversial and autologous stem cell rescue is only indicated in clinical trials. Autologous stem cell rescue was provided at the oncology department of Thomayer Teaching Hospital from September 1997 to May 2007 to 56 patients; as salvage chemotherapy to 32 patients with relapsed or refractory germ-cell tumours, and to 24 patients with adverse prognosis as primary first line treatment. The high-dose conditioning CARBOPEC protocol was used. The patients with persistence, relapse or progression of the disease had additional treatment. In the follow–up period ranging from 4 to 113 months (to September 2007), at present 42 (75 %) patients are alive and 14 (25 %) pts have died. Median time to progression (TTP) of all patients is 7 months, median overall survival (OS) is 52 months. Median disease free survival is (DFS) is 54 months (32 %) and median progression free survival (PFS), with or without additional treatment, of the surviving patients is 52 months (58 %). High-dose chemotherapy as upfront treatment for germ cell tumours with poor prognosis, and as salvage treatment in high risk tumours, seems to offer a good possibility of individual treatment.

Key words:
autologous transplantation, peripheral haematopoietic stem cells, high dose chemotherapy, germ cell tumours, salvage treatment, upfront treatment, additional treatment