Complete Remission of Progressive SLE after High-dose Chemotherapy and Autologous Hematopoietic Cell Transplantation for Relapsed Non-seminomatous Germ Cell Tumor

Objective: High dose chemotherapy and hematopoietic stem cell support remains a curative and accepted treatment option for relapsed or non-responsive germ cell tumors, and has been applied experimentally to control severe life-threatening autoimmune diseases. Case Report: In the present study, we report on a patient with systemic lupus erythematosous nephritis, not controllable with monthly cyclophosphamide pulses followed by immunosuppressive treatment with mycophenolate mofetil, developing a non-seminomatous germ cell tumor that had relapsed after standard chemotherapy and surgery. The patient received salvage chemotherapy with paclitaxel-ifosfamide-cisplatin (TIP) with G-CSF support for three cycles and hematopoietic stem cells were mobilized and harvested with leukapheresis after the first TIP cycle. This was followed by high-dose chemotherapy with carboplatin-etoposide-cyclophosphamide supported by autologous hematopoietic cell transplantation, based on its indication for the relapsed germ-cell tumor, leading to a complete remission of both the neoplastic and autoimmune disease that is sustained for more than 4 years after high-dose chemotherapy. Conclusion: Prolonged control of his relapsed germ cell tumor and systemic lupus erythematosous was attained with high dose chemotherapy and hematopoietic stem cell support. An extensive literature review is provided besides a detailed discussion of the above case.