Hematopoietic stem cell transplantation for extracranial germ cell tumors

Authors

DOI:

https://doi.org/10.46765/2675-374X.2025v6n1e291

Keywords:

Neoplasms, Germ Cell and Embryonal, Stem Cell Transplantation, Pediatrics

Abstract

Malignant extracranial germ cell tumors (GCT) are uncommon in the pediatric population. Most affected children can achieve cure using conventional chemotherapy combined with appropriate local control. The role of high-dose chemotherapy with autologous stem cell transplantation (HDCT/ASCT) in GCT has been studied mainly in adult cohorts. In this article, we reviewed the current evidence and indications for HDCT/ASCT in the management of pediatric GCT.

References

1. Poynter JN, Amatruda JF, Ross JA. Trends in incidence and survival of pediatric and adolescent patients with germ cell tumors in the United States, 1975 to 2006. Cancer. 2010;116(20):4882–91. https://doi.org/10.1002/cncr.25454 DOI: https://doi.org/10.1002/cncr.25454

2. Olson TA, Murray MJ, Rodriguez-Galindo C, Nicholson JC, Billmire DF, Krailo MD, Dang HM, Amatruda JF, Thornton CM, Arul GS, Stoneham SJ, Pashankar F, Stark D, Shaikh F, Gershenson DM, Covens A, Hurteau J, Stenning SP, Feldman DR, Grimison PS, Huddart RA, Sweeney C, Powles T, Lopes LF, dos Santos Agular S, Chinnaswamy G, Khaleel S, Abouelnaga S, Hale JP, Frazier AL. Pediatric and adolescent extracranial germ cell tumors: the road to collaboration. J Clin Oncol. 2015;33(27):3018–28. https://doi.org/10.1200/JCO.2014.60.5337 DOI: https://doi.org/10.1200/JCO.2014.60.5337

3. Lopes LF, Macedo CR, Pontes EM, Dos Santos Aguiar S, Mastellaro MJ, Melaragno R, Vianna SM, Lopes PA, Mendonça N, de Assis Almeida MT, Sonaglio V, Ribeiro KB, Santana VM, Schneider DT, de Camargo B. Cisplatin and etoposide in childhood germ cell tumor: brazilian pediatric oncology society protocol GCT-91. J Clin Oncol. 2009;27(8):1297–303. https://doi.org/10.1200/JCO.2008.16.4202 DOI: https://doi.org/10.1200/JCO.2008.16.4202

4. Lopes LF, Macedo CR, Aguiar Sdos S, Barreto JH, Martins GE, Sonaglio V, Milone M, Lima ER, Almeida MT, Lopes PM, Watanabe FM, D’Andrea ML, Pianovski MA, Melaragno R, Vianna SM, Moreira ME, Bruniera P, de Oliveira CZ. Lowered cisplatin dose and no bleomycin in the treatment of pediatric germ cell tumors: results of the GCT-99 protocol from the Brazilian Germ Cell Pediatric Oncology Cooperative Group. J Clin Oncol. 2016;34(6):603-10. https://doi.org/10.1200/JCO.2014.59.1420 DOI: https://doi.org/10.1200/JCO.2014.59.1420

5. Terenziani M, De Pasquale MD, Bisogno G, Biasoni D, Boldrini R, Collini P, Conte M, Dall’Igna P, Inserra A, Melchionda F, Siracusa F, Spreafico F, Barretta F, D’Angelo P. Malignant testicular germ cell tumors in children and adolescents: The AIEOP (Associazione Italiana Ematologia Oncologia Pediatrica) protocol. Urol Oncol. 2018;36(11):502.e7–e13. https://doi.org/10.1016/j.urolonc.2018.07.001 DOI: https://doi.org/10.1016/j.urolonc.2018.07.001

6. Prior D, Yang J, Nuño MM, Shaikh F, Frazier AL, Pashankar F. Standard-dose versus high-dose cisplatin for intermediate/poor-risk extracranial malignant germ cell tumors: re-analysis of pediatric oncology group 9049 and children’s cancer group 8882 trial using updated MaGIC risk stratification. Pediatr Blood Cancer. 2025;72(6):e31665. https://doi.org/10.1002/pbc.31665 DOI: https://doi.org/10.1002/pbc.31665

7. Lorch A, Bascoul-Mollevi C, Kramar A, Einhorn L, Necchi A, Massard C, De Giorgi U, Fléchon A, Margolin K, Lotz JP, Germà-Lluch JR, Powles T, Kollmannsberger C, Beyer J. Conventional-dose versus high-dose chemotherapy as first salvage treatment in male patients with metastatic germ cell tumors: evidence from a large international database. J Clin Oncol. 2011;29(16):2178–84. https://doi.org/10.1200/JCO.2010.32.6678 DOI: https://doi.org/10.1200/JCO.2010.32.6678

8. Faure-Conter C, Orbach D, Cropet C, Baranzelli MC, Martelli H, Thebaud E, Vérité C, Rome A, Fasola S, Corradini N, Rocourt N, Frappaz D, Kalfa N, Patte C. Salvage therapy for refractory or recurrent pediatric germ cell tumors: the French SFCE experience. Pediatr Blood Cancer. 2014;61(2):253–9. https://doi.org/10.1002/pbc.24730 DOI: https://doi.org/10.1002/pbc.24730

9. Pashankar F, Frazier AL, Krailo M, Xia C, Pappo AS, Malogolowkin M, Olson TA, Rodriguez-Galindo C. Treatment of refractory germ cell tumors in children with paclitaxel, ifosfamide, and carboplatin: A report from the Children’s Oncology Group AGCT0521 study. Pediatr Blood Cancer. 2018;65(8):e27111. https://doi.org/10.1002/pbc.27111 DOI: https://doi.org/10.1002/pbc.27111

10. De Pasquale MD, D’Angelo P, Crocoli A, Boldrini R, Conte M, Bisogno G, Spreafico F, Inserra A, Biasoni D, Dall’Igna P, Siracusa F, Miele E, Terenziani M. Salvage treatment for children with relapsed/refractory germ cell tumors: The Associazione Italiana Ematologia Oncologia Pediatrica (AIEOP) experience. Pediatr Blood Cancer. 2020;67(3):e28125. https://doi.org/10.1002/pbc.28125 DOI: https://doi.org/10.1002/pbc.28125

11. De Giorgi U, Rosti G, Slavin S, Yaniv I, Harousseau JL, Ladenstein R, Demirer T, Dini G; European Group for Blood and Marrow Transplantation Solid Tumours and Paediatric Disease Working Parties. Salvage highdose chemotherapy for children with extragonadal germ-cell tumours. Br J Cancer. 2005;93(4):412–7. https://doi.org/10.1038/sj.bjc.6602724 DOI: https://doi.org/10.1038/sj.bjc.6602724

12. Ussowicz M, Mielcarek-Siedziuk M, Musiał J, Stachowiak M, Węcławek-Tompol J, Sęga-Pondel D, Frączkiewicz J, Trelińska J, Raciborska A. Melphalan, etoposide, and carboplatin megatherapy with autologous stem cell transplantation in children with relapsing or therapy-resistant extracranial germ-cell tumors-A retrospective analysis. Cancers (Basel). 2020;12(12):3841. https://doi.org/10.3390/cancers12123841 DOI: https://doi.org/10.3390/cancers12123841

13. Villela NC, Seber A, Macedo CRPD, Zecchin VG, Guimarães RFDC, Faria TMV, Vidal DO, Jorge GEM, Navarro G, Lopes LF. High-dose chemotherapy with autologous stem cell transplantation for patients with extracranial germ cell tumors - experience of two Brazilian pediatric centers. Pediatr Hematol Oncol. 2023;40(6):539–53. https://doi.org/10.1080/08880018.2023.2187497 DOI: https://doi.org/10.1080/08880018.2023.2187497

14. Lew CZ, Liu HC, Hou JY, Huang TH, Yeh TC. Pediatric extracranial germ cell tumors: review of clinics and perspectives in application of autologous stem cell transplantation. Cancers (Basel). 2023; 15(7): 1998. https://doi.org/10.3390/cancers15071998

15. Necchi A, Mariani L, Di Nicola M, Lo Vullo S, Nicolai N, Giannatempo P, Raggi D, Farè E, Magni M, Piva L, Matteucci P, Catanzaro M, Biasoni D, Torelli T, Stagni S, Bengala C, Barone C, Schiavetto I, Siena S, Carlo-Stella C, Pizzocaro G, Salvioni R, Gianni AM. High-dose sequential chemotherapy (HDS) versus PEB chemotherapy as first-line treatment of patients with poor prognosis germ-cell tumors: mature results of an Italian randomized phase II study. Ann Oncol. 2015;26(1):167–72. https://doi.org/10.1093/annonc/mdu485 DOI: https://doi.org/10.1093/annonc/mdu485

16. Droz JP, Kramar A, Biron P, Pico JL, Kerbrat P, Pény J, Curé H, Chevreau C, Théodore C, Bouzy J, Culine S; Genito-Urinary Group of the French Federation of Cancer Centers (GETUG). Failure of high-dose cyclophosphamide and etoposide combined with double-dose cisplatin and bone marrow support in patients with high volume metastatic non seminomatous germ-cell tumours: mature results of a randomised trial. Eur Urol. 2007;51(3):739–46; discussion 747–8. https://doi.org/10.1016/j.eururo.2006.10.035 DOI: https://doi.org/10.1016/j.eururo.2006.10.035

17. Motzer RJ, Nichols CJ, Margolin KA, Bacik J, Richardson PG, Vogelzang NJ, Bajorin DF, Lara PN Jr, Einhorn L, Mazumdar M, Bosl GJ. Phase III randomized trial of conventional-dose chemotherapy with or without high-dose chemotherapy and autologous hematopoietic stem-cell rescue as first-line treatment for patients with poor-prognosis metastatic germ cell tumors. J Clin Oncol. 2007;25(3):247–56. https://doi.org/10.1200/JCO.2005.05.4528 DOI: https://doi.org/10.1200/JCO.2005.05.4528

18. Daugaard G, Skoneczna I, Aass N, De Wit R, De Santis M, Dumez H, Marreaud S, Collette L, Lluch JRG, Bokemeyer C, Schmoll HJ. A randomized phase III study comparing standard dose BEP with sequential high-dose cisplatin, etoposide, and ifosfamide (VIP) plus stem-cell support in males with poor-prognosis germ-cell cancer. An intergroup study of EORTC, GTCSG, and Grupo Germinal (EORTC 30974). Ann Oncol. 2011;22(5):1054–61. https://doi.org/10.1093/annonc/mdq575 DOI: https://doi.org/10.1093/annonc/mdq575

19. Grupo Cooperativo Latinoamericano de Tratamento dos Tumores de Células Germinativas em Crianças e Adolescentes. Protocolo TCG-GALOP-2017 [Internet]. Grupo Cooperativo Latinoamericano de Tratamento dos Tumores de Células Germinativas em Crianças e Adolescentes; 2018 [cited Mar 25,2025]. Available at: https://cipe.org.br/novo/wp-content/uploads/2020/05/PROTOCOLO_TCG_2017.pdf

20. Secondino S, Badoglio M, Rosti G, Labopin M, Delaye M, Bokemeyer C, Seidel C, Kanfer E, Metafuni E, Finke J, Bouhris JH, Kosmas C, Malard F, Pagani A, Kuball J, Koehl U, Ruggeri A, De Giorgi U, Pedrazzoli P; EBMT Cellular Therapy & Immunobiology WP. High-dose chemotherapy with autologous stem cell transplants in adult primary non-seminoma mediastinal germ-cell tumors. A report from the Cellular Therapy and Immunobiology working party of the EBMT. ESMO Open. 2024;9(9):103692. https://doi.org/10.1016/j.esmoop.2024.103692 DOI: https://doi.org/10.1016/j.esmoop.2024.103692

21. Motzer RJ, Sheinfeld J, Mazumdar M, Bains M, Mariani T, Bacik J, Bajorin D, Bosl GJ. Paclitaxel, ifosfamide, and cisplatin second-line therapy for patients with relapsed testicular germ cell cancer. J Clin Oncol. 2000;18(12):2413–8. https://doi.org/10.1200/JCO.2000.18.12.2413 DOI: https://doi.org/10.1200/JCO.2000.18.12.2413

22. Pico JL, Rosti G, Kramar A, Wandt H, Koza V, Salvioni R, Theodore C, Lelli G, Siegert W, Horwich A, Marangolo M, Linkesch W, Pizzocaro G, Schmoll HJ, Bouzy J, Droz JP, Biron P; Genito-Urinary Group of the French Federation of Cancer Centers (GETUG-FNCLCC), France; European Group for Blood and Marrow Transplantation (EBMT). A randomised trial of high-dose chemotherapy in the salvage treatment of patients failing first-line platinum chemotherapy for advanced germ cell tumours. Ann Oncol. 2005; 16(7): 1152–9. https://doi.org/10.1093/annonc/mdi228 DOI: https://doi.org/10.1093/annonc/mdi228

23. Feldman DR, Huddart R, Hall E, Beyer J, Powles T. Is high dose therapy superior to conventional dose therapy as initial treatment for relapsed germ cell tumors? The TIGER Trial. J Cancer. 2011;2:374–7. https://doi.org/10.7150/jca.2.374 DOI: https://doi.org/10.7150/jca.2.374

24. Feldman DR, Sheinfeld J, Bajorin DF, Fischer P, Turkula S, Ishill N, Patil S, Bains M, Reich LM, Bosl GJ, Motzer RJ. TI-CE high-dose chemotherapy for patients with previously treated germ cell tumors: results and prognostic factor analysis. J Clin Oncol. 2010;28(10):1706–13. https://doi.org/10.1200/JCO.2009.25.1561 DOI: https://doi.org/10.1200/JCO.2009.25.1561

25. Adra N, Abonour R, Althouse SK, Albany C, Hanna NH, Einhorn LH. High-dose chemotherapy and autologous peripheral-blood stem-cell transplantation for relapsed metastatic germ cell tumors: the Indiana University Experience. J Clin Oncol. 2017;35(10):1096–102. https://doi.org/10.1200/JCO.2016.69.5395 DOI: https://doi.org/10.1200/JCO.2016.69.5395

26. Lorch A, Kleinhans A, Kramar A, Kollmannsberger CK, Hartmann JT, Bokemeyer C, Rick O, Beyer J. Sequential versus single high-dose chemotherapy in patients with relapsed or refractory germ cell tumors: longterm results of a prospective randomized trial. J Clin Oncol. 2012;30(8):800–5. https://doi.org/10.1200/JCO.2011.38.6391 DOI: https://doi.org/10.1200/JCO.2011.38.6391

27. Gössi F, Spahn M, Zweifel M, Panagiotis S, Mischo A, Stenner F, Hess U, Berthold D, Bargetzi M, Schardt J, Pabst T. Comparison of three or fewer high-dose chemotherapy cycles as salvage treatment in germ cell tumors in first relapse. Bone Marrow Transplant. 2017;52(2):334–6. https://doi.org/10.1038/bmt.2016.285 DOI: https://doi.org/10.1038/bmt.2016.285

28. Bin Riaz I, Umar M, Zahid U, Husnain M, Iftikhar A, McBride A, Bilal J, Javed A, Akbar S, Singh P, Ali Z, Sipra Quar, Gondal FR, Ahman F, Anwer F. Role of one, two and three doses of high-dose chemotherapy with autologous transplantation in the treatment of high-risk or relapsed testicular cancer: a systematic review. Bone Marrow Transplant. 2018;53(10):1242–54. https://doi.org/10.1038/s41409-018-0188-3 DOI: https://doi.org/10.1038/s41409-018-0188-3

29. Rick O, Bokemeyer C, Weinknecht S, Schirren J, Pottek T, Hartmann JT, Braun T, Rachud B, Weissbach L, Hartmann M, Siegert W, Beyer J. Residual tumor resection after high-dose chemotherapy in patients with relapsed or refractory germ cell cancer. J Clin Oncol. 2004;22(18):3713–9. https://doi.org/10.1200/JCO.2004.07.124 DOI: https://doi.org/10.1200/JCO.2004.07.124

30. Miller MI, Feifer A, Feldman DR, Carver BS, Bosl GJ, Motzer RJ, Bajorin DF, Sheinfeld J. Surgical management of patients with advanced germ cell tumors following salvage chemotherapy: Memorial Sloan Kettering Cancer Center (MSKCC) experience. Urology. 2019;124:174–8. https://doi.org/10.1016/j.urology.2018.09.024 DOI: https://doi.org/10.1016/j.urology.2018.09.024

31. Francolini G, Trodella LE, Marvaso G, Matrone F, Nicosia L, Timon G, Ognibene L, Vinciguerra A, Franzese C, Borghetti P, Arcangeli S. Radiotherapy role in non-seminomatous germ cell tumors, radiobiological and technical issues of an unexplored scenario. Int J Clin Oncol. 2021;26(10):1777–83. https://doi.org/10.1007/s10147-021-01989-7 DOI: https://doi.org/10.1007/s10147-021-01989-7

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Published

11/26/2025

How to Cite

Villela, N. C., Ikeuti, P. S., Klinger, P. H. dos S., Zanette, A., Castro Junior, C. G. de, & Lopes, L. F. (2025). Hematopoietic stem cell transplantation for extracranial germ cell tumors. JOURNAL OF BONE MARROW TRANSPLANTATION AND CELLULAR THERAPY, 6(1). https://doi.org/10.46765/2675-374X.2025v6n1e291

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