Background: HDC is a curative therapy for relapsed GCT. However, multiple prior relapses, cisplatin refractoriness (relapse/progression (PD) within 4 weeks) or absolute refractoriness (no prior response), or very high tumor markers at relapse predict poor early event-free survival (EFS). The validated Beyer model (JCO 1996;14:2638) identifies groups with poor risk (5% EFS at 1-year post-HDC), intermediate risk (25% EFS) or good risk (≥50% EFS). Given high VEGF expression in metastatic GCT and synergy between BEV and chemotherapy, we studied concurrent BEV/HDC in refractory GCT. Methods: Eligibility includes ≥ 1^st relapse/PD, poor/interm risk and no contraindications to HDC or BEV. Treatment consisted of 2 cycles of HDC with stem-cell support following BEV (5 mg/kg) 1 week before each cycle. HDC-1 consists of a novel regimen of infusional gemcitabine with docetaxel/melphalan/carboplatin (BBMT 2005;11:297). HDC-2 includes ifosfamide/carboplatin/etoposide. Target accrual is 25 pts, to distinguish a 1-yr expected EFS of 15% (median time to progression [TTP], 9 months) from 50% 1-year EFS (median TTP, 2 years). Results: 21 pts have been treated, median age 22 (range, 19-45) poor risk (N=15) or interm risk (N=6), cisplatin refractoriness (N=9) or absolute refr (N=12), median 3 prior relapses (1-4), median 3 prior regimens (2-6), PD at HDC: 11 pts. Tumor sites: lungs (N=15), liver (8), bones (5), brain (5), retroperit (15), mediast (12). Histol at Dx: embryonal ca (4), chorio (3), mixed with teratoma (14). Prior surgery for metastases: 8 pts (6 abdomen, 1 liver, 1 brain). Prior radiation: 6 pts. Toxicity of HDC-1: grade 3 mucositis in all pts, rash (8 G2, 2 G3) and transaminase elevation; 2 pts with marginal baseline renal function died from early sepsis; 1 pt died from late fungal pneumonia. After HDC-1, markers normalized in 14/17 evaluable pts. 15 pts received HDC-2 at a median 49 (38-66) days after 1^st stem cell infusion, which was well tolerated. 8 pts had residual lesions resected with findings of either teratoma (N=2) or no viable tumor (N=6). With median follow-up of 23 (3-43) months, 14 pts are alive in CR (67% EFS). Conclusions: BEV with HDCx2 shows encouraging preliminary results in heavily pretreated refractory GCT.