Annals of Oncology Advance Access published online on October 11, 2009
Annals of Oncology, doi:10.1093/annonc/mdp366
High-dose chemotherapy (HDCT) as second-salvage treatment in patients with multiple relapsed or refractory germ-cell tumors
1 Departments of Hematology and Oncology, Universitätsklinikum Giessen und Marburg GmbH, Marburg
2 Departments of Hematology and Oncology, Vivantes Klinikum Am Urban, Berlin
3 Departments of Hematology and Oncology, Charite Campus Mitte, Berlin
4 Departments of Hematology and Oncology, South West German Comprehensive Cancer Center, Tübingen
5 Departments of Hematology and Oncology, Klinik Reinhardshöhe, Bad Wildungen
6 Departments of Oncology, Hematology and BMT with section Pneumology, Hubertus Wald Tumorzentrum - UCCH University Medical Center Hamburg Eppendorf, Hamburg, Germany
* Correspondence to: Dr J. Beyer, Departments of Hematology and Oncology, Vivantes Klinikum Am Urban, Dieffenbachstrasse 1, 10967 Berlin, Germany. Tel. +49-30-1302-22100; Fax: +49-30-1302-22105; E-mail: joerg.beyer{at}vivantes.de
Background: Survival after high-dose chemotherapy (HDCT) as second-salvage treatment (SST) in multiple relapsed germ-cell tumors (GCTs).
Patients and methods: Existing databases in Berlin and Marburg of HDCT trials from 1989 to 2008 were retrospectively screened. Among 534 patients, 71 of 534 (13%) patients were scheduled for HDCT having failed previous conventional-dose first-line and first-salvage chemotherapy regimens; those 49 patients who had received at least cisplatin plus etoposide first-line as well as conventional-dose cisplatin-based first-salvage regimens and were diagnosed after 1 January 1990 were further analyzed.
Results: Median age at SST was 32 years (range 19–52 years). Median follow-up for surviving patients was 4 years (range 1.7–8.5 years). Three of 49 (6%) patients either progressed or died before scheduled HDCT; the remaining 46 of 49 (94%) received either single or sequential HDCT. The rate of favorable responses to HDCT was 27 of 49 (55%). Nine patients remain alive and free of progression. One additional patient was lost to follow without progression at 4 years. The projected overall survival rate at 5 years was 17% (95% confidence intervals 7% to 30%).
Conclusion: HDCT can induce remissions in patients with multiple relapsed GCTs with a long-term survival rate of 
17%.
autologous transplantation, chemotherapy, germ-cell tumor, retrospective study, salvage therapy, testicular cancer
Received for publication February 27, 2009. Revision received April 10, 2009. Accepted for publication June 16, 2009.