Autologous hematopoietic cell transplantation in adult patients with germ cell tumors and soft tissue sarcomas

The prognosis of recurrent or refractory solid tumors is dismal and few patients have experienced prolonged survival. For patients with metastatic neuroblastoma or Ewing`s sarcoma treated conventionally, the prognosis for disease-free survival 3 years from the diagnosis remains < 20 per cent. Conventional-dose salvage approaches to patients with poor risk, recurrent or refractory germ cell tumors lead to remission in 30-60% of patients, but only 20% gain long-term survival. High dose chemotherapy has been considered an attractive approach in the treatment of patients with chemo-or radiosensitive malignancies for the late eighties. Transplant numbers increased massively for several years. A change in attitude occured in 1997. Doubts about initial reports, failures of prospective controlled studies brought about this change. Phase II trials indicate a 10 proc. improvement in survival with early intensification of salvage treatment using high dose chemotherapy in patients suffering from germ cell tumors. However, no advantage was observed according to the results of a large randomized trial. We are still waiting for results of three prospective, randomized trials evaluating the role of autologous stem cell transplantation in a first line setting. For young adults with neuroblastoma, Ewing` s sarcoma or soft tissue sarcomas the same approach as in paediatric patients can be used, and prospective phase III trials suggest an advantage of high dose chemotherapy in patients with neuroblastoma. Data from many transplant centers at least suggest that neuroblastoma and Ewing's sarcoma and probably soft tissue sarcomas are correctly considered to be accepted indications for autologous stem cell transplantation.