Article Text

Download PDFPDF
High-Dose Chemotherapy With Autologous Stem Cell Support as Salvage Therapy in Recurrent Gestational Trophoblastic Disease
  1. Benedict B. Benigno, MD
  1. Gynecologic Oncology, Northside Hospital, Atlanta, GA; and Ovarian Cancer Institute, Atlanta, GA.
  1. Address correspondence and reprint requests to Benedict B. Benigno, MD, Ovarian Cancer Institute, 960 Johnson Ferry Rd, Suite 130, Atlanta, GA 30342. E-mail:


Background Gestational trophoblastic disease usually follows a molar pregnancy but can occur also after an abortion or a term pregnancy. In only 10% of cases will treatment be required; and usually, single-agent chemotherapy will suffice. In high-risk disease, the multiagent regimen EMA-CO is usually used; and if that fails, most oncologists will use the EMA-EP regimen. If this does not produce a remission, there is no unanimity of opinion as to how to proceed. Numerous salvage regimens are in current use, and some centers do not consider high-dose chemotherapy.

Case A young woman presented 4 months after a normal spontaneous delivery with an elevated human chorionic gonadotropin level and multiple pulmonary metastases. She failed both the EMA-CO and EMA-EP regimens as well as additional standard chemotherapy. She was then treated with 4 separate courses of high-dose chemotherapy with autologous stem cell support, which produced a complete remission.

Conclusion Even patients with high-risk gestational trophoblastic disease are usually cured with standard chemotherapy. Patients who fail such treatment should be considered for high-dose chemotherapy.

  • Gestational trophoblastic disease
  • Molar pregnancy
  • EMA-CO
  • EMA-EP

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • The author declares no conflict of interest.