Gemcitabine, Docetaxel, Melphalan, Carboplatin as Part of Sequential Cycles of High-Dose Chemotherapy With Autologous Hematopoietic Stem-Cell Rescue for Multiply Relapsed/Refractory Pediatric Germ Cell Tumors

Although most malignant germ cell tumors (GCTs) are highly curable with cisplatin-based therapy, options for patients with multiply relapsed/refractory disease remain limited. For this population, we report the first pediatric use of gemcitabine, docetaxel, melphalan, and carboplatin (GemDMC) as part of sequential cycles of high-dose chemotherapy with autologous hematopoietic stem cell rescue (aHSCR). Three of the four patients had extensive metastases, four were cisplatin-resistant, and three patients achieved CR. All patients experienced manageable, reversible toxicities with no significant delays in engraftment. Our findings suggest that including GemDMC as a component of sequential aHSCR is a promising salvage strategy for pediatric patients with relapsed/refractory metastatic GCT.