Ifosfamide, epirubicin and etoposide regimen as salvage and mobilizing therapy for relapsed/refractory lymphoma patients.
OBJECTIVE
Therapy for relapsed/refractory lymphomas should be based only on drugs not included in the front-line chemotherapy regimens. We adopted the strategy of using salvage chemotherapy to debulk disease and simultaneously mobilize stem cells, using a regimen based on ifosfamide and etoposide, (drugs not usually used for front-line treatment).


METHODS
A three-drug combination of ifosfamide, epirubicin and etoposide (IEV) was used to treat 62 patients with relapsing or refractory aggressive non-Hodgkin's lymphoma (NHL; n=51) or Hodgkin's disease (HD; n=11). Forty-five of the patients were studied for the feasibility of peripheral blood stem cell (PBSC) harvest.


RESULTS
The overall and complete response (CR) rates were, respectively, 77% and 32% in the NHL subset and 81% and 45% in the HD subset. Among the 17 patients who achieved CR after IEV but did not have a subsequent transplantation, the median duration of the response was 9 months (range, 2 to 14 months). Mobilization was successful in 33 of 45 (71%) patients. Among the 45 who proceeded to autotransplantation, 27 (60%) were in CR status after the autograft; 23/45 (51%) patients are currently in continuous CR with a median follow-up of 25 months (range, 10-68 months); the relapse-free survival curve shows 83% in this state at 60 months. Twenty-three (37%) patients are currently in continuous CR with a median follow-up of 25 months. Clinical and hematologic toxic effects were mild.


CONCLUSIONS
Our results indicate the efficacy of the IEV regimen in inducing a good remission rate. IEV is a predictable and highly effective mobilization regimen in relapsed/refractory patients with aggressive NHL or HD.
Zinzani
Pier Luigi
PL
Istituto di Ematologia e Oncologia Medica L. e A. Seràgnoli, Policlinico S.Orsola, via Massarenti 9, 40138 Bologna, Italy. plzinzo@med.unibo.it
Tani
Monica
M
Molinari
Anna Lia
AL
Stefoni
Vittorio
V
Zuffa
Eliana
E
Alinari
Lapo
L
Gabriele
Annalisa
A
Bonifazi
Francesca
F
Salvucci
Marzia
M
Tura
Sante
S
Baccarani
Michele
M
D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D015251:Epirubicin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D019650:Hematopoietic Stem Cell Mobilization; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D008223:Lymphoma / Q000188:drug therapy* / Q000401:mortality / Q000628:therapy; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012008:Recurrence; D012074:Remission Induction; D016879:Salvage Therapy; D033581:Stem Cell Transplantation; D014182:Transplantation, Autologous; D016896:Treatment Outcome
D015251:Epirubicin; D005047:Etoposide; D007069:Ifosfamide