[Germ cell tumor]

Germ cell tumor (GCT) is chemotherapy-sensitive, and with the development of a cisplatin combined regimen, the majority of patients can now be cured. Seventy percent to 80% of patients with advanced GCT have a lasting complete response to a cisplatin combined regimen, while 20 to 30% of these patients are refractory to the therapy. Refractory GCT patients need more effective and intense therapy. In order to overcome the conventional dose chemotherapy results, high-dose chemotherapy backed by autologous hematopoietic stem cell transplantation (AHSCT), has been applied to patients with GCT who have relapsed after achieving a complete response by first-line chemotherapy or to those in whom disease progression or the failure to achieve CR had occurred after initial and/or ifosfamide combined salvage therapy. The therapy with a high-dose combination of CBDCA (Carboplatin), VP-16 (Etoposide) and CPM (Cyclophosphamide) or IFM (Ifosfamide), supported with AHSCT is administered to the advanced GCT patients. The response rate (CR+PR) ranges from 40 to 78% by reported groups averaging about 50%, and disease-free survival is possible in about half the survivors thus far. Treatment related morbidity and mortality are observed, but are tolerable with the above dosage. Thanks to the technical development of collecting hematopoietic stem cells using either bone marrow or peripheral blood, and hematopoietic growth factor to lessen hematologic toxicities and obtain early hematological recovery, this method can be performed more safely. High-dose chemotherapy with AHSCT may well become more effective in patients with resistant GCT by a new combination of synergistic drugs or multicycle transplants.