Role of autologous bone marrow transplantation in germ-cell cancer.

The results of high-dose chemotherapy and autologous bone marrow transplantation in 388 patients with germ-cell tumors have been reported. It is clear that one or two cycles of various combinations of etoposide, cyclophosphamide, ifosfamide, cisplatin, and carboplatin can be administered with acceptable toxicity, and it appears that high doses of etoposide and oxazophosphorine derivatives increase the cure rate. Cyclophosphamide may be preferable to ifosfamide, because it seems less toxic. The need for and the dose and mode of administration of carboplatin remain in question. In patients with refractory disease, the long-term results of high-dose therapy and marrow transplantation are poor, with cure rates of 8% to 20%, but there is no clear alternative. As consolidation treatment after conventional salvage chemotherapy, early results suggest benefit, but randomized trials are needed. As first-line treatment in patients with high-risk disease, the results to date demonstrate no benefit over available therapy.