RATIONALE: Germ cell tumors (GCT) are highly sensitive to chemotherapy such that even with metastatic disease at diagnosis, many patients can be cured. Patients who fall into the poor risk category or others who relapse can be successfully salvaged with high dose chemotherapy and autologous stem cell transplant (AuSCT). As in other diseases such as myeloma, sequential high dose chemotherapy and AuSCT may improve overall and disease free survival. PURPOSE: Because prior investigations in GCT suggest that a subset of high risk or relapsed patients may be cured with sequential cycles of high dose chemotherapy and AuSCT, we propose investigating how well non-cross resistant conditioning regimens work in treating patients with relapsed or high risk GCT.
OBJECTIVES: Primary * Determine overall survival (OS) of patients with germ cell tumors treated with tandem autologous stem cell transplantation with non-cross-resistant conditioning regimens. Secondary * Determine disease-free survival (DFS) of patients treated with this regimen. * Determine the toxicity of tandem transplants * Determine the time to engraftment of neutrophils and platelets in patients treated for each transplant * Determine the number of patients unable to adequately mobilize sufficient peripheral blood stem cells (PBSC) for tandem transplantation. * Identify prognostic factors of patients unlikely to mobilize sufficient PBSC for tandem transplantation. * Compare OS and DFS of patients undergoing single vs tandem transplantation. OUTLINE: * Peripheral blood stem cell (PBSC) mobilization with filgrastim (G-CSF): Patients receive G-CSF subcutaneously (SC) beginning on day 1 and continuing until stem cell collection is complete. Patients undergo stem cell collection beginning on day 5 of G-CSF administration and continuing for at least 3 collections until the collection goal is met. * Second PBSC mobilization with chemotherapy: Patients not meeting the collection goal receive cyclophosphamide IV over 2 hours on day 1 and G-CSF SC beginning on day 4 and continuing until stem cell collection is complete. Patients meeting the collection goal after PBSC mobilization via G-CSF alone or in combination with chemotherapy will undergo tandem autologous transplantation. If collection goal is not met but the patient has collected \> or = 2 x 10\^6 CD34 cells/kg, a single autologous transplant will be performed. * Single stem cell transplantation (SCT): Patients receive paclitaxel IV over 3 hours on day -7 and ifosfamide IV on days -6 to -4. Patients undergo reinfusion of stem cells on day 0. Patients also receive G-CSF SC or IV beginning on day 1 and continuing until blood counts recover. * Tandem SCT: Patients receive treatment as in single SCT. Beginning 30-90 days later, patients receive carboplatin IV over 60 minutes and thiotepa IV over 30 minutes on days -6 to -4 and etoposide IV over 60 minutes on days -6 to -3. Patients undergo reinfusion of stem cells on day 0. Patients also receive G-CSF SC or IV beginning on day 5 and continuing until blood counts recover. After completion of study treatment, patients are followed at 6, 9, and 12 months and then every 6 months for up to 2 years. PROJECTED ACCRUAL: A total of 25 patients will be accrued for this study.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
23
Days -6, -5, -4: 500mg/m2\^/day intravenously (IV) over 60 minutes
600mg/m\^2/day intravenously (IV) over 60 minutes on Days -6 through -3.
2500 mg/m\^2/day continuous infusion intravenously on Days -6, -5 and -4.
225 mg/m\^2 intravenous over 3 hours on Day -7.
150mg/m\^2/day intravenously IV over 30 minutes; Days -6, -5 and -4
Peripheral blood stem cell infusion (\< 4 x 10\^6 CD34+ cells/kg)
2500 mg/m\^2/day continuous infusion intravenously on Days -6, -5 and -4.
Beginning Day 5, G-CSF 5 μg/kg/day until absolute neutrophil count (ANC) ≥ 1500/UL for 3 consecutive days.
Masonic Cancer Center at University of Minnesota
Minneapolis, Minnesota, United States
Overall Survival (OS)
The percentage of people in a study or treatment group who are alive for a certain period of time after they were diagnosed with or treated for a disease, such as cancer. Also called survival rate.
Time frame: 1 Year
Disease-free Survival (DFS)
The number of patients who survive without any signs of symptions of that cancer or any other cancer.
Time frame: 1 Year
Engraftment of Platelets
Platelet engraftment is defined as 20,000/mm\^3 (20 x 10\^9/L) for 3 consecutive days unsupported by a platelet transfusion.
Time frame: Day 100
Numbers of Patients Unable to Mobilize Peripheral Blood Stem Cells
Number of patients unable to achieve adequate stem cell mobilization, need to undergo one or tandem transplantation. Stem cell mobilization = A process in which certain drugs are used to cause the movement of stem cells from the bone marrow into the blood. The stem cells can be collected and stored. They may be used later to replace the bone marrow during a stem cell transplant.
Time frame: Pre-Transplant
Engraftment of Neutrophils
Neutrophil engraftment is defined as the first day of three consecutive days where the neutrophil count (absolute neutrophil count) is 500 cells/mm3 (0.5 x 109/L) or greater.
Time frame: Day 42
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