High-dose infusional ifosfamide, etoposide plus methylprednisolone followed by dexamethasone, high-dose ara-C and cisplatinum and autologous stem cell transplantation for refractory or relapsed aggressive non-Hodgkin's lymphoma.

Abstract

BACKGROUND AND OBJECTIVES:

A salvage program including infusional high-dose ifosfamide plus etoposide (IFOVM) was evaluated in patients with refractory or relapsed aggressive non-Hodgkin's lymphoma.

DESIGN AND METHODS:

Forty-six patients were included. IFOVM consisted of ifosfamide (10 g/m2 as a 72-hour continuous infusion), etoposide (900 mg/m2) and methylprednisolone; responding patients underwent two cycles of DHAP and subsequently an autologous peripheral blood stem cell transplantation (APBSCT) with BEAM as the conditioning regimen.

RESULTS:

All but one patient showed tumor regression following IFOVM. Myelosuppression was brief but 26 patients developed neutropenic fever. All but two patients proceeded to DHAP. Overall response rate to IFOVM/DHAP was 59% (29% CR and 30% PR). Refractory patients had a significantly lower response rate than relapsed patients (39% vs. 85% p=0.002). All refractory patients with intermediate-high or high IPI progressed during IFOVM/DHAP. Twenty-seven patients proceeded to APBSCT. Two-year overall survival of patients with low or low-intermediate IPI was 47% [95% CI 25-69%], which was significantly better than that obtained in patients with intermediate-high or high IPI (11% [95% CI 0-22%] p=0.0001).

INTERPRETATION AND CONCLUSIONS:

This sequential regimen of IFOVM, followed by DHAP and consolidated with BEAM is active in relapsed or refractory patients with low or low-intermediate IPI aggressive lymphoma. However, it has little activity in those patients with intermediate or high IPI, especially in refractory lymphomas.

• Authors: Antonio Salar, Rodrigo Martino, Granada Perea, José María Ribera, Armando López-Guillermo, Ramón Guardia, Lourdes Escoda, Albert Altés, Jorge Sierra, Emili Montserrat
• Journal: Haematologica (Haematologica) Vol. 87 Issue 10 Pg. 1028-35 (Oct 2002) ISSN: 0390-6078 [Print] Italy
• PMID: 12368156 (Publication Type: Journal Article)

Chemical References

• Cytarabine
• Etoposide
• Dexamethasone
• Cisplatin
• Ifosfamide
• Methylprednisolone

Topics

• Adult
• Aged
• Antineoplastic Combined Chemotherapy Protocols (administration & dosage, therapeutic use)
• Cisplatin (administration & dosage)
• Combined Modality Therapy
• Cytarabine (administration & dosage)
• Dexamethasone (administration & dosage)
• Disease-Free Survival
• Etoposide (administration & dosage)
• Female
• Humans
• Ifosfamide (administration & dosage)
• Lymphoma, Non-Hodgkin (drug therapy, mortality)
• Male
• Methylprednisolone (administration & dosage)
• Middle Aged
• Recurrence
• Salvage Therapy
• Stem Cell Transplantation
• Time Factors