High-Dose Chemotherapy and Stem Cell Transplant in Treating Patients With Metastatic Germ Cell Tumors That Have Not Responded to First-Line Therapy

DISEASE CHARACTERISTICS:

• Histologically confirmed germ cell tumor (GCT) based on pathologic review at INT Milan

  • Metastatic disease
  • Relapsed or refractory disease
• Prior chemotherapy treatment for GCT without a pathologic diagnosis due to unequivocal clinical evidence of GCT and an urgent need to start therapy (elevated alpha-fetoprotein [AFP] or human chorionic gonadotropin [HCG] with pattern of metastases consistent with GCT and high tumor burden) allowed

• Unequivocal progression of measurable disease, consisting of abnormalities on 2-dimensional imaging or raised tumor markers, following 1 line of cisplatin-based chemotherapy as documented by either of the following:

  • Tumor biopsy of new, growing, or unresectable lesions demonstrating viable non-teratomatous GCT (enrollment on this study for adjuvant treatment after resection of viable GCT not allowed)
  • Increasing or abnormally elevated serum tumor markers (HCG or AFP) (increasing lactate dehydrogenase [LDH] alone does not constitute progressive disease)
• Received ≥ 3 and ≤ 6, cisplatin-based chemotherapy courses as part of first-line (initial) chemotherapy and ≤ 6 cisplatin-based chemotherapy courses

• Brain metastases allowed

  • May be treated with radiotherapy and/or surgery concurrently with cisplatin, ifosfamide, and etoposide regimen

    • Radiotherapy should not be given concurrently with mobilization phase/leukapheresis and high-dose carboplatin and etoposide

PATIENT CHARACTERISTICS:

• WBC ≥ 2,000/µL
• ANC ≥ 1,500/µL
• Platelet count ≥ 100,000/µL
• Creatinine clearance ≥ 50 cc/min (unless renal dysfunction is due to tumor obstructing the ureters, in which case eligibility will be determined by the principal investigator)
• AST/ALT < 2 times upper limit of normal (ULN) (< 5 times ULN if due to hepatic metastases)
• Total bilirubin < 1.5 times ULN
• Ejection fraction ≥ 50% by echocardiogram

• Negative serology for the following infectious diseases:

  • HIV type 1 and 2
  • Hepatitis B surface antigen (active carriers)
  • Hepatitis C
  • Cytomegalovirus (serum Ag p65 ± PCR confirmation at principal investigator discretion)

PRIOR CONCURRENT THERAPY:

• See Disease Characteristics
• Recovered from prior surgery
• At least 3 weeks since prior chemotherapy
• No prior high-dose chemotherapy with peripheral blood stem cell rescue
• No more than 1 prior chemotherapy regimen for metastatic disease