Tandem High Dose Chemotherapy With Autologous Bone Marrow Transplantation in Germ Cell Tumor— Experience From a Tertiary Care Center From South India

Abstract

Background: The use of high-dose chemotherapy with autologous hematopoietic cell transplantation is well established as a potentially curative approach in patients with relapsed or refractory disease in testicular Germ cell tumours after initial cisplatin-based chemotherapy. The use of tandem transplant with high-dose carboplatin and etoposide conditioning has been a tried and is a feasible option in relapse setting.Overall, HDCTand Autologous stem cell transplant can offer cure rates of up to 60% in the relapsed GCTsetting. Data on Tandem HDCTand ASCTis very limited in Indian subcontinent. Hence we report our experience with respect to safety, efcacy and tolerability, survival outcomes of HDCT/ ASCT in patients with relapsed GCT. Methods: Patients who were diagnosed with relapsed or refractory Germ cell tumours and underwent Tandem HDCT and ASCT were analysed from patient records from 2013 to 2020. Results: Both our patients received BEP (bleomycin, etoposide, and cisplatin) as rst-line therapy. HDCT was done after 2nd line salvage chemotherapies in both patients. Both patients were treated with 2 courses of High-dose carboplatin (700mg/m2) and etoposide(750mg/m2) as conditioning regimen followed by stem cell rescue(CD34+ stem cells yield – 5 to 6x106 cells/kg ) 3-4 weeks apart. Grade ¾ toxicities including myelosuppression, diarrhea, mucositis were observed in both patients. After ASCT both patients were followed up with imaging and serial monitoring of tumour markers. 1st patient died 3 months after ASCT due to disease relapse and our 2nd patient was disease free for 22 months, after which he developed progressive disease in brain and succumbed to disease. Conclusion: This is the rst report from India on tandem HDCT with ACST in relapsed GCTs. Tandem HDCT/ASCT seems to be safe and feasible option in relapsed/ refractory testicular GCT's.