title: Etoposide, ifosfamide, and methotrexate with or without bleomycin in refractory or recurrent lymphomas.
abstract: The prognosis of patients with refractory or relapsed malignant lymphoma is poor. To improve the outcome of such patients, a therapeutic regimen of VIM +/- B (etoposide/ifosfamide plus mesna/methotrexate/ with or without bleomycin) was administered. Of 47 patients treated, 15 had relapsed following complete remission (CR) after first-line chemotherapy, 28 had failed to achieve CR with first-line therapy, and four failed to respond to multiple salvage regimens. All patients had received extensive prior chemotherapy, and 36 had received combinations containing doxorubicin. Eight patients had low-grade non-Hodgkin's lymphoma (NHL), 28 had high-grade NHL, and 11 patients had Hodgkin's disease. Overall response rate was 87%, with 45% CR and 42% partial remission (PR). Median relapse-free interval was 8 months in patients with CR and 6 months in those with PR. Of patients with CR, 43% were predicted to be without relapse at 2 years and 31% at 5 years. Median survival time for all patients treated with 14 months-22 months for those with CR and 10 months for those with PR. Probability of survival at 2 years was 30% in all patients, 50% in patients with CR, and 15% in those with PR. VIM +/- B appears to be effective against refractory or recurrent lymphoma, resulting in response in a large number of patients and long-term survival and possible cure in a small but significant number. Results indicate that VIM +/- B is particularly effective in patients with high-grade NHL who have responded suboptimally to primary therapy.
authors.affiliation: West German Tumor Center, Department of Internal Medicine (Cancer Research), University of Essen, Department of Internal Medicine (Cancer Research), Hufelandstr. 55, 4300 Essen 1, FRG.
authors.forename: M R
authors.initials: MR
authors.lastname: Nowrousian
authors.forename: C H
authors.initials: CH
authors.lastname: Anders
authors.forename: N
authors.initials: N
authors.lastname: Niederle
authors.forename: M
authors.initials: M
authors.lastname: Nagel-Hiemke
authors.forename: T
authors.initials: T
authors.lastname: Moritz
authors.forename: S
authors.initials: S
authors.lastname: Seeber
authors.forename: C G
authors.initials: CG
authors.lastname: Schmidt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001761:Bleomycin / Q000008:administration & dosage; D004341:Drug Evaluation; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006689:Hodgkin Disease / Q000188:drug therapy; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D008223:Lymphoma / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D012074:Remission Induction; D015996:Survival Rate
chemical_list: D001761:Bleomycin; D005047:Etoposide; D007069:Ifosfamide; D008727:Methotrexate