METASTATIC BONE-MARROW INVOLVEMENT IN MALIGNANT GERM-CELL TUMORS

Background: Bone marrow involvement (BMI) appears to be a rare event in patients (PTS) with germ cell tumors (GCT). Results: Three PTS with GCT and metastatic BMI have been observed. Two PTS were classified as clinical stage (CS) I at initial diagnosis, one PT had advanced disease, constituting a prognostically bad group. All three PTS had LDH levels above 1,000 U/I at detection of BMI. Two of 3 PTS showed severe thrombocytopenia (<20,000/mul) at the time of BMI diagnosis. The increase of the specific tumor markers AFP or beta-HCG was only marginal prior to the detection of BMI. Two PTS reached a complete remission after treatment with aggressive cisplatinum-based chemotherapy (CTX), but ultimately relapsed in the bone marrow and died of progressive disease. One PT died due to thrombocytopenia and hyperfibrinolysis during the primary episode of BMI. Conclusion: The incidence of metastatic BMI in PTS with advanced GCT according to results of different treatment centers was 4 in 329 (1.2 %). Clinically, bone marrow biopsies should be considered in PTS with prolonged thrombocytopenia after chemotherapy, especially in cases of elevated LDH levels.