難治性精巣腫瘍に対するPBSCT併用超大量化学療法 - PBSCT研究会・精巣腫瘍分科会による多施設共同臨床試験 -

Abstract

Indiana分類advanced disease 42例のうちBEP療法3コース終了後に, 腫瘍マーカーが正常化しなかった16例に対してPBSCT併用超大量化学療法を1コース行い検討した.超大量化学療法1コースでは十分な効果があるとはいえなかった.とくにhCG-βが高値の症例に対しては効果が不十分であった.BEP療法によるPBSCの採取効率は良好で, 移植後の造血機能回復も速やかであった

The efficacy and toxicity of a single cycle of high-dose chemotherapy with peripheral blood stem cell autotransplantation (PBSCT) in patients with poor-risk testicular germ cell tumors (GCT) enrolled in the Japan Blood Cell Transplantation Study Group was investigated. Previously untreated poor-risk testicular GCT patients were treated with BEP therapy (cisplatin, etoposide and bleomycin) with or without high-dose chemotherapy (carboplatin, etoposide and ifosphamide) followed by PBSCT. Patients were qualified for a change to high-dose chemotherapy if elevated serum tumor markers (human chorionic gonadotropin-beta, alpha-fetoprotein and lactate dehydrogenase) was observed after 3 cycles of BEP therapy. Eighteen patients were treated with BEP therapy alone and 16 with BEP and high-dose chemotherapy. At the completion of high-dose chemotherapy, all tumor markers had returned to normal in 6 patients. Among them, 1 had only teratoma found at resection and 5 had carcinoma resected. Nine patients who had persistent elevation of any tumor marker were treated with high-dose chemotherapy or another anticancer drug. Thirteen are alive (81%) and 9 (56%) are continuously disease-free at a median follow up of 11 months. The median time from PBSCT to a granulocyte count > 500/microL was 9.5 days and to a platelet count > 50, 000/microL was 13 days.