Professional Statements and Societal Positions Guidelines
National Comprehensive Cancer Network - 2022
CNS Embryonal Tumors - v.1.2022
Current National Comprehensive Cancer Network guidelines on treating central nervous system tumors make the following recommendations about hematopoietic cell transplant (HCT):
- For medulloblastoma and supratentorial primitive neuroectodermal tumor, autologous HCT for localized recurrent disease with maximum safe resection is a category 2A recommendation (based upon lower-level evidence, there is uniform NCCN consensus that the intervention is appropriate).
Bone Cancer - v.2.2022
- Osteosarcoma- The safety and efficacy of HDT/HCT in individuals with locally advanced, metastatic, or relapsed osteosarcoma have also been evaluated.453,454 In the Italian Sarcoma Group study, treatment with carboplatin and etoposide was followed by stem cell rescue, combined with surgery-induced complete response in chemosensitive disease.454 Transplant-related mortality was 3.1%. The 3-year OS and DFS rates were 20% and 12%, respectively. The efficacy of this approach in individuals with high-risk disease is yet to be determined in prospective randomized studies.
- Ewing Sarcoma - High-dose therapy followed by hematopoietic cell transplant (HDT/HCT) has been evaluated in individuals with localized as well as metastatic disease. HDT/HCT has been associated with potential survival benefit in individuals with non-metastatic disease. However, studies that have evaluated HDT/HCT in individuals with primary metastatic disease have shown conflicting results
- Rhabdomyosarcoma - HCT not addressed
Germ Cell Tumors
Testicular Cancer - v.2.2022
Current National Comprehensive Cancer Network guidelines on testicular cancer state that second-line chemotherapy regimens for metastatic germ cell tumors include high-dose chemotherapy with stem cell support.
Ovarian Cancer - v.3.2022
Current National Comprehensive Cancer Network guidelines on ovarian cancer state that individuals with recurrent or residual malignancy after multiple chemotherapeutic regimens may be treated with a recurrence modality (see Principles of Systemic Therapy: Acceptable Systemic Therapy Regimens - Malignant Germ Cell/Sex Cord-Stromal Tumors in the algorithm), including potentially curative high-dose chemotherapy or TIP. Other regimens include VAC (vincristine, dactinomycin, cyclophosphamide), VeIP (vinblastine, ifosfamide, cisplatin), VIP (etoposide, ifosfamide, cisplatin), cisplatin/etoposide, docetaxel/carboplatin, paclitaxel/carboplatin, paclitaxel/gemcitabine, paclitaxel/ifosfamide, docetaxel, paclitaxel, RT, or supportive care only. These recurrence regimens (see Principles of Systemic Therapy: Systemic Therapy Regimens - Malignant Germ Cell/Sex Cord-Stromal Tumors in the algorithm) are not generalizable for all of the uncommon histology tumors; therefore, individuals should be referred to tertiary care institutions for treatment.
