STEM CELL TRANSPLANTATION AS A TREATMENT OPTION FOR RELAPSED/REFRACTORY GERM CELL TUMORS

Malignant germ cell tumors (GT) arise from abnormal migration of primordial germ cells and are histologically identical whether they occur inside or outside of central nervous system (CNS) (1). They are divided into two heterogenous groups: germinomas and non-germinomatous germ cell tumors according to histological findings. Although the optimal treatment strategy remains a matter of debate, they generally respond well to surgery, radiotherapy, chemotherapy, or a combination of all and are characterized by a good survival rate (2). The surgical strategy for GCTs varies depending on the location of the tumor. Surgery is only a standard care option for low grade extracranial GCTs because it is unlikely to achieve negative tumor margins when the tumor is located inside CNS (2). Patients with relapsed or progressive despite initial chemotherapy are candidates for salvage therapy (3). Patients relapsing after definite treatment of locoregional disease are to be treated by stage adopted first line standard therapy for metastatic disease. Patients with primary advanced/metastatic disease failing one line of cisplatin based combination chemotherapy can benefit from high dose chemotherapy and stem cell rescue (4). Although stem cell transplantation following high dose chemotherapy can be beneficial, either two or three consecutive cycles of high dose chemotherapy with repetition after blood count recovery may contribute to overall survival rates.