Washington (H24N). High-dose chemotherapy followed by bone marrow or peripheral stem cell transplant rescue has proven to be an effective treatment for relapsed testicular cancer, bringing the cure rate for this disease as a whole up to 85 percent.

Only 30 percent of testicular cancer patients relapse: seventy percent are cured by the initial round of surgery and chemotherapy alone. Between 1992 and 1998, Lawrence H. Einhorn, MD, and his associates at Indiana University Medical Center in Indianapolis treated 65 relapsed testicular cancer patients with high-dose chemotherapy followed by bone marrow rescue. A round of chemotherapy with carboplatin and etoposide was followed by the bone marrow replenishing techniques, then another round of chemotherapy was administered. If x-rays showed residual tumors after the second round, the tumors were surgically removed. Side effects were significant but controllable, and there were no deaths from the procedure. After an average of three years of follow-up, 57 percent of patients treated with this regimen remained free of disease, which is significant because relapses, if they occur, usually do so within a year after treatment.

Einhorn’s work is reported in the October issue of the Journal of Clinical Oncology, which is published by the American Society of Clinical Oncology (ASCO). In a statement from ASCO, Einhorn said, "This is a message of hope. For patients who are not cured with the initial chemotherapy, we can now tell them with confidence that there is more than a 50 percent chance they can still be cured with second-line therapy."

High-dose chemotherapy is being used more frequently as bone marrow salvage techniques like peripheral stem cell transplants and autologous bone marrow transplants come into their own. High-dose chemotherapy kills cancer cells, but it also kills the bone marrow where red and white blood cells and platelets (which clot the blood) are made. Before bone marrow transplants, chemotherapy had to be stopped before it completely destroyed the marrow.

Originally, bone marrow transplants were only used to treat leukemia, aplastic anemia, multiple myeloma and other bone marrow diseases. The transplants were expensive, came from unrelated donors and were sometimes rejected with fatal results. To avoid rejection and provide therapy for patients who didn’t have donor matches, transplants using the patient’s own bone marrow (autologous transplants) were developed. Diseased bone marrow was removed, cleansed of malignant cells, and given back to the patient. The technique soon gave birth to the idea of using autologous bone marrow transplants to restore marrow destroyed by chemotherapy so higher doses of drugs could be given.

Peripheral stem cell transplants are turning out to be even more effective than bone marrow transplants. They use the patient’s bone marrow stem cells that have escaped to the circulating blood. The stem cells are taken from blood samples instead of the bone marrow, considerably reducing expense and patient discomfort, and are grown and expanded in laboratories. Stem cells are the bone marrow’s starter cells and have the ability to create red cells, white cells, and platelets. Properly cultured, stem cells can replace all these basic blood components and fully restore damaged bone marrow.

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