High-dose thiotepa, etoposide and carboplatin as conditioning regimen for autologous stem cell transplantation in patients with relapsed or refractory germ cell tumors
Purpose: As well as standard chemotherapy, autologous stem cell transplantation (ASCT) is also seen as a good therapeutic alternative in the relapsed/refractory germ cell tumors (GCT). The combination of thiotepa, carboplatin and etoposide (TECA) is also one of the high-dose chemotherapy options that can be used before ASCT. Except a phase-II study there are no large studies conducted with the TECA regimen in GCT. In this study, we aimed to evaluate the efficacy and toxicity of the TECA regimen in patients who underwent ASCT. Methods: Patients who underwent ASCT with TECA for relapsed/refractory GCT in our center between 2013-2020 were included in the study. Results: The median age of 15 patients included in the study was 31 years (19-46). The majority of patients (n=12; 80.0%) had a diagnosis of non-seminoma GCT. All of the patients had previously received bleomycin, etoposide, cisplatin (BEP) combination chemotherapy. They were relapsed/refractory to platinums and had at least one distant metastasis. ASCT was administered as a second-line therapy in 12 (80.0%) patients. In all patients etoposide, thiotepa and carboplatin were administered before ASCT as myeloablative therapy. Complete response was obtained in 6 (40.0%) patients and partial response in 5 (33.3%). The objective response rate was 73.3%. Three-year progression-free survival (PFS) was 43.1% and the estimated median PFS was 12.6 months (2.7- 41.7). The estimated median overall survival (OS) was 37.3 months and 3-year OS was 54.5%. None of the patients had ASCT-related death. Conclusions: High-dose TECA is an effective and safe myeloablative regimen for ASCT in relapsed/refractory GCT
