Ultrahigh-dose chemoherapy with peripheral blood stem cell autotransplantation for patients with chemotherapy-resistant and/or poor prognostic testicular cancer

对5例化疗耐药和/或预后不良的睾丸癌患者进行了超高剂量化疗和外周血干细胞自体移植（PBSCT）联合治疗。3例为腹部转移瘤，1例为多发肺转移瘤，1例为腹部和肺部转移瘤。年龄31 ~ 50岁（平均36.8岁）。给予大剂量依托泊苷（500mg/m^2X4天）治疗，收集外周血干细胞。服用大剂量依托泊苷后。rG-CSF（250杯/体）从最低点开始给药。骨髓恢复时用Fenwall CS-3000血细胞分离器采集血单个核细胞。通过不连续Percoll梯度离心获得富集干细胞的组分，用患者血清和DMSO保存在液氮中。单次采血收集的外周血粒细胞-巨噬细胞集落形成单位（CFU-GM）平均为25.8 × 10^5/kg体重。此外，根据我们以往的研究，每次分离中可以收集到超过2.0X10^5/kg体重的CFU-GM，这是足够安全进行PBSCT的剂量。所有患者均采用顺铂（20mg/m^2X5天）、依托泊苷（100mg/m^2X5天）、博来霉素（15mgX3天）联合治疗。3例患者对BEP治疗有反应并获得CR，其余2例患者未能达到CR，随后接受卡铂（200mg/m^2X4天）、依托泊苷（250mg/m^2X4天）、环磷酰胺（50mg/kgX2天）等超高剂量化疗，并进行PBSCT治疗。他们对这种治疗有反应，分别获得了153个月的CR。结果表明，该方法对化疗耐药和/或预后不良的睾丸癌患者很有希望。

A combination of ultrahigh-dose chemotherapy and peripheral blood stem cell autotransplantation (PBSCT) for 5 patients with chemotherapy-resistant and/or poor prognostic testicular cancer was evaluated. Three patients had bulky abdominal metastases, 1 had multiple pulmonary metastases and 1 had bulky abdominal and pulmonary metastases. Ages ranged from 31 to 50 (ave.36.8 yrs). They were treated with high-dose etoposide (500mg/m^2X4 days) in order to collect peripheral blood stem cells. After the administration of high-dose etoposide. rG-CSF(250 mug/body) was administered from nadir state. Blood mononuclear cells were collected using a Fenwall CS-3000 blood cell separator during bone marrow recovery. Fractions enriched for stem cells were obtained by discontinuous Percoll gradient centrifugation and were stored in liquid nitrogen using patient's sera and DMSO.The mean number of peripheral blood granulocyte-macrophage-colony-forming units (CFU-GM) collected by one apheresis was 25.8X10^5/kg body weight. In addition, CFU-GM more than 2.0X10^5/kg body weight could be collected in each apheresis, which was though to be sufficient dosis to perform PBSCT in safe, based upon our previous studies. All the patients were treated by a combination of cisplatin (20mg/m^2X5 days), etoposide (100mg/m^2X5 days) and bleomycin (15mgX3 days). Three patients responded to BEP therapy and obtained a CR, however, remaining 2 patients failed to achieve CR, who was later treated by ultrahigh-dose chemotherapy including carboplatin (200mg/m^2X4 days), etoposide (250mg/m^2X4 days) and cyclophosphamide (50mg/kgX2 days) followed by PBSCT.They responded to this therapy and obtained a CR for 15, 3 months, respectively. The results suggested the method was promising for patients with chemotherapy-resistant and/or poor prognostic testicular cancer.