Hochdosischemotherapie mit autologem Stammzellsupport für Patienten mit AFP-produzierendem Germinom im Rezidiv

We report of a 34-year old man with second intracranial relapse of a suprasellar germinoma. Despite of extensive pretreatment with radiation and conventional chemotherapy relapse occurred and was treated with sequential high-dose chemotherapy followed by transfusion of autologous peripheral stem cells. The high-dose chemotherapy course was complicated by refractory derailment of pineal gland insufficiency. The patient achieved a complete remission after high dose chemotherapy which lasted for 13 months. Subsequently, he developed a third relapse and died.Wir berichten über einen 34 Jahre alten Patienten mit zweitem intrakraniellem Rezidiv eines suprasellären Germinoms. Trotz intensiver Vorbehandlung mit Bestrahlung und konventioneller Chemotherapie kam es zum Rezidiv und der Patient wurde mit sequentieller Hochdosischemotherapie mit autologem Stammzellensupport behandelt. Während der Hochdosischemotherapie kam es zu einer refraktären Entgleisung einer Pinealdrüsen-Insuffizienz. Der Patient erreichte eine komplette Remission nach Hochdosischemotherapie, die für 13 Monate anhielt. Er starb nach diesem Zeitraum im Rahmen des dritten Rezidivs

Hochdosischemotherapie mit autologem Stammzellsupport für Patienten mit AFP-produzierendem Germinom im Rezidiv

We report of a 34-year old man with second intracranial relapse of a suprasellar germinoma. Despite of extensive pretreatment with radiation and conventional chemotherapy relapse occurred and was treated with sequential high-dose chemotherapy followed by transfusion of autologous peripheral stem cells. The high-dose chemotherapy course was complicated by refractory derailment of pineal gland insufficiency. The patient achieved a complete remission after high dose chemotherapy which lasted for 13 months. Subsequently, he developed a third relapse and died.Wir berichten über einen 34 Jahre alten Patienten mit zweitem intrakraniellem Rezidiv eines suprasellären Germinoms. Trotz intensiver Vorbehandlung mit Bestrahlung und konventioneller Chemotherapie kam es zum Rezidiv und der Patient wurde mit sequentieller Hochdosischemotherapie mit autologem Stammzellensupport behandelt. Während der Hochdosischemotherapie kam es zu einer refraktären Entgleisung einer Pinealdrüsen-Insuffizienz. Der Patient erreichte eine komplette Remission nach Hochdosischemotherapie, die für 13 Monate anhielt. Er starb nach diesem Zeitraum im Rahmen des dritten Rezidivs

Administration of bortezomib before and after autologous stem cell transplantation improves outcome in multiple myeloma patients with deletion 17p

In patients with multiple myeloma (MM), risk stratification by chromosomal abnormalities may enable a more rational selection of therapeutic approaches. In the present study, we analyzed the prognostic value of 12 chromosomal abnormalities in a series of 354 MM patients treated within the HOVON-65/GMMG-HD4 trial. Because of the 2-arm design of the study, we were able to analyze the effect of a bortezomib-based treatment before and after autologous stem cell transplantation (arm B) compared with standard treatment without bortezomib (arm A). For all analyzed chromosomal aberrations, progression-free survival (PFS) and overall survival (OS) were at least equal or superior in the bortezomib arm compared with the standard arm. Strikingly, patients with del(17p13) benefited the most from the bortezomib-containing treatment: the median PFS in arm A was 12.0 months and in arm B it was 26.2 months (P = .024); the 3 year-OS for arm A was 17% and for arm B it was 69% (P = .028). After multivariate analysis, del(17p13) was an independent predictor for PFS (P < .0001) and OS (P < .0001) in arm A, whereas no statistically significant effect on PFS (P = .28) or OS (P = .12) was seen in arm B. In conclusion, the adverse impact of del(17p13) on PFS and OS could be significantly reduced by bortezomib-based treatment, suggesting that long-term administration of bortezomib should be recommended for patients carrying del(17p13). This trial is registered at the International Standard Randomised Controlled Trial Number Register as IS-RCTN64455289. (Blood. 2012;119(4): 940-948