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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: benedict.benigno@ugynonc.com.

Abstract

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

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Footnotes

  • The author declares no conflict of interest.

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