Interview with Dr. Rong-Long Chen, Convener of the Pediatric Cancer Multidisciplinary Team: How Triple-Tandem Transplantation Cured a Metastatic, Relapsed Germ-Cell Tumor

At twenty-three, “Ah-Chih” (a pseudonym) learned he had a mediastinal germ-cell tumor, a cancer known for its speed and aggression. Surgeons removed the mass, chemotherapy followed, and prophylactic radiation completed what was, on paper, a textbook course. One year later his tumor markers spiked. A second operation found nothing malignant, yet strange symptoms soon appeared—tongue swelling on one side, slurred speech, left-ear tinnitus, stabbing pain behind the left occiput, and a sense of pressure in one eye. Imaging pinpointed a skull-base lesion: the original tumor had returned and spread.

Accepting a case most centers avoid

Although germ-cell tumors are now listed by the American Society of Clinical Oncology as one of five landmark advances—survival for metastatic cases once measured in months now stretches toward cure—some patients remain refractory. Ah-Chih was in that minority. He traveled north to Koo Foundation Sun Yat-Sen Cancer Center (KFSYSCC) to see Dr. Rong-Long Chen, renowned for four decades of work in pediatric hematology-oncology and stem-cell transplantation. Dr. Chen trained at National Taiwan University and Children’s Hospital Los Angeles, where he earned an AACR Young Investigator Award for immune-based research.

International data show that relapsed cases like Ah-Chih’s survive only four percent of the time without high-dose transplantation. A single high-dose rescue nudges the figure to roughly ten percent, and long-term survivors are nearly unseen. Drawing on close collaboration with Memorial Sloan Kettering, Dr Chen proposed triple-tandem transplantation, a sequence published by Dr Darren Feldman. KFSYSCC became the first hospital in Taiwan to try it for metastatic, relapsed germ-cell tumors.

Triple-tandem transplantation in practice

The protocol delivers three rounds of high-dose chemotherapy, each followed by autologous stem-cell infusion, all within two months. Chemotherapy wipes out cancer and, unfortunately, normal marrow. Infused stem cells restore blood production before the next assault, leaving malignant cells no time to recover. Dr. Chen explained the science and risks; encouraged by family, Ah-Chih agreed. More than ten years have passed without recurrence.

Following this success, the center treated three additional patients with mediastinal germ-cell tumors that had relapsed. Two are now considered cured. Overall, ten high-risk patients have undergone the procedure; five are likely cured, and one has recently completed therapy and remains under observation.

When is triple-tandem needed?

Germ-cell tumors range from common teratoma and yolk-sac tumor to rarer embryonal carcinoma, choriocarcinoma, and gonadoblastoma. Choriocarcinoma is especially perilous because it travels through blood vessels and can trigger catastrophic bleeding. Most germ-cell tumors respond to surgery combined with tailored chemotherapy or, when indicated, radiation. Triple-tandem transplantation is reserved for the few that relapse aggressively after standard care.

Why KFSYSCC succeeds

The treatment carries real risk. Patients must tolerate powerful drugs, the tumor must remain chemo-sensitive, and physicians must harvest an adequate supply of stem cells before starting. Since 2012 KFSYSCC has built a transplant platform supported by specialists in nursing, nutrition, infectious-disease control, pharmacy, pathology, neurology, respiratory therapy, intensive care, endocrinology, rehabilitation, psychosocial care, and surgery. Pharmacokinetic monitoring keeps drug levels therapeutic yet safe, social workers secure funding for costly mobilizing agents, and a rigorous infection-control system guards every step.

Frequently asked questions

What is a germ-cell tumor?

Primordial germ cells normally migrate during embryonic development to form ovaries or testes. If they stray or mutate, tumors can arise not only in those organs but also in the brain, sacrococcygeal area, mediastinum, retroperitoneum, and other sites.

At what ages do germ-cell tumors appear, and what symptoms should raise suspicion?

They occur at any age, with peaks before age five and during adolescence. Testicular tumors present as painless scrotal lumps; ovarian tumors cause pain, nausea, or vomiting; sacrococcygeal tumors protrude at birth; intracranial tumors lead to headache, vomiting, or blurred vision; mediastinal tumors may cause cough, shortness of breath, or chest pain.

Can children receive triple-tandem transplantation?

Most pediatric germ-cell tumors respond to conventional surgery and chemotherapy. Only a small, high-risk subset requires triple-tandem therapy.

What side effects accompany the procedure?

High-dose chemotherapy can cause nausea, hair loss, mucositis, infections, sore throat, or abdominal bloating. These symptoms are usually temporary and subside once treatment ends.

Is the treatment covered by insurance?

Some medications fall outside Taiwan’s National Health Insurance. Physicians can file special applications for reimbursement on a case-by-case basis.

Triple-tandem transplantation now offers a sixty-percent or better chance of cure at KFSYSCC, bringing hope to patients once deemed beyond rescue.