Salvage treatment for children with relapsed/refractory germ cell tumors: The Associazione Italiana Ematologia Oncologia Pediatrica (AIEOP) experience: Pediatric Blood and Cancer

M.D. De Pasquale, P. D'Angelo, A. Crocoli, R. Boldrini, M. Conte, G. Bisogno, F. Spreafico, A. Inserra, D. Biasoni, P. Dall'Igna, F. Siracusa, E. Miele, M. Terenziani

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Background: Malignant germ cell tumors (GCTs) are a heterogeneous group of rare neoplasms in children. Optimal outcome is achieved with multimodal therapies for patients with both localized and advanced disease, especially after the introduction of platinum-based chemotherapy regimens. In this respect, data on salvage treatment for children with relapsed or platinum-refractory disease are still limited. Methods: Retrospective analysis of data regarding patients affected by malignant GCTs with platinum-refractory or relapsed disease after first-line treatment according to AIEOP TCGM 2004 protocol was conducted. Results: Twenty-one patients, 15 females and 6 males, were considered for the analysis. All 21 patients received second-line conventional chemotherapy (SLCT), two of these immediately after surgery for local relapse removal. Two patients showed a progression of disease during SLCT and died of disease shortly thereafter, whereas 19 patients were in partial remission (PR) or complete remission (CR) after SLCT. Treatment after SLCT consisted in surgery on residual tumor mass (9/19) followed by high dose of chemotherapy (HDCT) with autologous hematopoietic stem cell support (16/19). The overall survival (OS) and event-free survival of the whole populations are 71% and 66.6%, respectively. Platinum-refractory patients OS is 54.5% compared with 91.5% of the relapsed group. There were no treatment-related deaths. Conclusion: SLCT followed or not by HDCT is an effective salvage treatment for children with relapsed/refractory GCTs. However, the role of HDCT following SLCT needs to be further investigated, especially regarding the identification of specific patient subgroups, which can benefit from this more intensive treatment. © 2019 Wiley Periodicals, Inc.
Original languageEnglish
JournalPediatr. Blood Cancer
Issue number3
Publication statusPublished - 2020


  • germ cell tumors
  • high-dose chemotherapy
  • pediatric tumors
  • refractory tumors
  • relapsed tumors
  • antineoplastic metal complex
  • bleomycin
  • carboplatin
  • cisplatin
  • cyclophosphamide
  • doxorubicin
  • etoposide
  • gemcitabine
  • ifosfamide
  • melphalan
  • oxaliplatin
  • paclitaxel
  • thiotepa
  • tumor marker
  • antineoplastic agent
  • deoxycytidine
  • adolescent
  • Article
  • autologous hematopoietic stem cell transplantation
  • bacteremia
  • cancer combination chemotherapy
  • cancer growth
  • cancer radiotherapy
  • cancer recurrence
  • cancer regression
  • cancer surgery
  • cancer survival
  • child
  • childhood cancer
  • choriocarcinoma
  • clinical article
  • controlled study
  • drug megadose
  • embryonal carcinoma
  • event free survival
  • female
  • follow up
  • germ cell tumor
  • graft versus host reaction
  • human
  • infant
  • male
  • mediastinum cancer
  • mixed tumor
  • mucosa inflammation
  • multiple cycle treatment
  • ovary teratoma
  • overall survival
  • pediatric surgery
  • preschool child
  • priority journal
  • relapsed refractory germ cell tumor
  • retrospective study
  • sacrococcygeal region
  • salvage therapy
  • school child
  • testis cancer
  • transplantation conditioning
  • urogenital tract sarcoma
  • yolk sac tumor
  • drug effect
  • drug resistance
  • neoplasm
  • pathology
  • prognosis
  • remission
  • survival rate
  • tumor recurrence
  • Adolescent
  • Antineoplastic Combined Chemotherapy Protocols
  • Carboplatin
  • Child
  • Child, Preschool
  • Cisplatin
  • Deoxycytidine
  • Drug Resistance, Neoplasm
  • Etoposide
  • Female
  • Follow-Up Studies
  • Humans
  • Ifosfamide
  • Infant
  • Male
  • Neoplasm Recurrence, Local
  • Neoplasms, Germ Cell and Embryonal
  • Oxaliplatin
  • Paclitaxel
  • Prognosis
  • Remission Induction
  • Retrospective Studies
  • Salvage Therapy
  • Survival Rate


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