Salvage high-dose chemotherapy for children with extragonadal germ-cell tumours

Abstract

We reviewed the European Group for Blood and Marrow Transplantation (EBMT) experience with salvage high-dose chemotherapy (HDC) in paediatric patients with extragonadal germ-cell tumour (GCT). A total of 23 children with extragonadal GCT, median age 12 years (range 1 -20), were treated with salvage HDC with haematopoietic progenitor cell support. The GCT primary location was intracranial site in nine cases, sacrococcyx in eight, retroperitoneum in four, and mediastinum in two. In all, 22 patients had a nongerminomatous GCT and one germinoma. Nine patients received HDC in first-and 14 in second-or third-relapse situation. No toxic deaths occurred. Overall, 16 of 23 patients (70%) achieved a complete remission. With a median follow-up of 66 months (range 31 -173 months), 10 (43%) are continuously disease-free. Of six patients who had a disease recurrence after HDC, one achieved a disease-free status with surgical resection followed by chemotherapy and radiotherapy. In total, 11 patients (48%) are currently disease-free. Eight of 14 patients (57%) with extracranial primary and three of nine patients (33%) with intracranial primary GCT are currently disease-free. HDC induced impressive long-term remissions as salvage treatment in children with extragonadal extracranial GCTs. Salvage HDC should be investigated in prospective trials in these patients.

Management of CNS germinoma

“…Chemotherapy regimens may include such agents as cisplatin-etoposideifosfamide, cisplatin-etoposide and etoposidecarboplatin. High-dose chemotherapy with autologous stem cell rescue conditioned with carboplatin and etoposide or etoposide and thiotepa can be used in patients who relapsed followed by RT [24]. Time to relapse can vary.…”

Extragonadal Germ Cell Tumors: A Review With Emphasis on Pathologic Features, Clinical Prognostic Variables, and Differential Diagnostic Considerations

“…Most studies of pediatric GCTs include both neonates and older children, making it difficult to discern the precise pathology and clinical course of extragonadal GCTs in the older child. [2][3][4][5][6] A recent study has suggested that age Z12 years is a significantly adverse prognostic factor, especially for thoracic tumors, and therefore may represent the transition point to adult type tumors. 7 In addition to prognostic differences, it is well documented that pediatric GCTs are distinct from adult GCTs cytogenetically.…”

Langzeitverlauf bei Patienten mit suprasellären Germinomen

“…kleinere unkontrollierte Pilotstudien, in denen ebenfalls über langfristige Heilungserfolge in mehr als 50% der Fälle berichtet wird [1,13] [5,8,16,25]. Bei Tumorrezidiven finden Hochdosis-Chemotherapien Verwendung, wobei deren Stellenwert als Erstlinientherapie jedoch noch unklar ist [6].…”