The role of stem cell transplntation for ovarian germ cell tiumors is evolving. The European Group for Blood and Marrow Transplantation (Urbano-Ispizua et al, 2002) recently stated that for ovarian cancer with minimal residue disease, allogeneic transplantation is not generally recommended; while autologous transplantation may be undertaken in approved clinical protocols — the value of transplants for patients included in this category needs further investigation. For refractory ovarian cancer, allogeneic transplantation using sibling donor is developmental (there is very little experience with this particular type of transplant); while allogeneic transplantation using alternative donor or autologous transplantation is not generally recommended. For relapsed germ cell tumors that were sensitive to chemotherapy, allogeneic transplantation is not generally recommended, while autologous transplantation is standard use in selected patients. For refractory germ cell tumors, allogeneic transplantation is not generally recommended; while autologous transplantation may be undertaken in approved clinical protocols.
The stem cell collection can be approved in cases in which there is an anticipation of being unable to obtain a durable complete response. In such a situation, NCCN (p.24) recomemnds high dose therapy (with stem cell transplantation)
Transplantation is being tested in poor-risk germ cell tumors in both males and females but trials so far do not show that it is superior to chemotherapy alone.
Research on the role of autologous verus allogneeic and on schedule and preparative regimens transplantation in germ cell tumors is still ongoing. There is little known on tandem or 2nd transplants for this patient population and such transpalnt asre certainly experiemental at the present time.
R. J. Motzer, C. J. Nichols, K. A. Margolin, J. Bacik, P. G. Richardson, N. J. Vogelzang, D. F. Bajorin, P. N. Lara Jr, L. Einhorn, M. Mazumdar, et al.
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., January 20, 2007; 25(3): 247 – 256.