title: Combination of ifosfamide, methotrexate, and etoposide (IMVP) as a salvage therapy for relapsed and refractory aggressive non-Hodgkin lymphoma: retrospective study.
abstract: OBJECTIVE
  There are contradictory reports on the outcomes of IMVP (ifosfamide, methotrexate, and etoposide) treatment in patients with aggressive non-Hodgkin s lymphomas. Our aim was to evaluate retrospectively the results of this treatment in our institution.
  
  
  METHODS
  Twenty eight patients with refractory or relapsed aggressive non-Hodgkin s lymphomas received IMVP between April 1997 and June 2001. Median follow-up of the survivors was 24 months. There were 15 women and 13 men, aged 15-68 years. Twelve patients were refractory to primary treatment. The number of previous treatment lines varied between one and five. The overall response rate to IMVP treatment was 39%, with 6 patients achieving complete and 5 partial response/remission. Eleven patients received a subsequent hematopoietic stem cell transplant after IMVP therapy.
  
  
  RESULTS
  Median duration of the survival for all patients was 6 months, and the response duration for responders 6 months. Nine patients had grade 3 hematologic toxicity or higher, 5 developed significant infectious complications, and one developed the tumor lysis syndrome. There was one treatment-related death due to infection. The patients with a low or low-intermediate international prognostic index at the start of IMVP had a significantly better survival and progression-free survival rates than those with high or high-intermediate score. Seven patients with hematopoietic stem cell transplant were alive in December 2001.
  
  
  CONCLUSIONS
  IMVP is an active regimen with acceptable level of toxicity in patients with relapsed or refractory aggressive non-Hodgkin s lymphoma. However, outcomes of this treatment are unsatisfactory and better treatment is still needed.
authors.affiliation: Division of Hematology, Department of Medicine, Zagreb University Hospital Center, Kispaticeva 12, Croatia. aurer@mef.hr
authors.forename: Igor
authors.initials: I
authors.lastname: Aurer
authors.forename: Nadira
authors.initials: N
authors.lastname: Duraković
authors.forename: Ivo
authors.initials: I
authors.lastname: Radman
authors.forename: Damir
authors.initials: D
authors.lastname: Nemet
authors.forename: Silva
authors.initials: S
authors.lastname: Zupancić-Salek
authors.forename: Jasminka
authors.initials: J
authors.lastname: Kovacević-Metelko
authors.forename: Vinko
authors.initials: V
authors.lastname: Bogdanić
authors.forename: Dubravka
authors.initials: D
authors.lastname: Sertić
authors.forename: Mirando
authors.initials: M
authors.lastname: Mrsić
authors.forename: Mirta
authors.initials: M
authors.lastname: Mikulić
authors.forename: Boris
authors.initials: B
authors.lastname: Labar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D005047:Etoposide / Q000627:therapeutic use*; D006801:Humans; D007069:Ifosfamide / Q000627:therapeutic use*; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D016879:Salvage Therapy; D016019:Survival Analysis
chemical_list: D005047:Etoposide; D007069:Ifosfamide; D008727:Methotrexate