ICE (ifosfamide, carboplatin, etoposide) as second-line chemotherapy in relapsed or primary progressive aggressive lymphoma--the Nordic Lymphoma Group experience.
OBJECTIVE
To evaluate ICE (ifosfamide, carboplatin, etoposide) as second-line chemotherapy in relapsed or primary progressive aggressive lymphoma, in terms of objective response rate (ORR) and peripheral blood stem cell (PBSC) harvest mobilization rate.


METHODS
A total of 40 patients were included, with a median age of 57 yr. The major histopathological subgroup was diffuse large B-cell lymphoma (n = 27). The indication for ICE was relapse in 23 patients, primary progressive disease in 11, transformation in four and adjuvant primary chemotherapy in one patient.


RESULTS
After three cycles of ICE, the ORR was 59%. Among patients with primary progressive disease, ORR was 36% (four of 11). A PBSC harvest after ICE could be performed in 11 of 20 patients, and was sufficient for stem cell rescue in 10 of 20. The median number of collected CD34+ cells was 3.6 x 10(6) (range 1.4-12.5). In six of 10 patients, an adequate PBSC harvest could be performed with a second mobilization regimen.


CONCLUSIONS
In this patient population, the rate of response to ICE was comparable with other second-line regimens used in aggressive lymphoma. The rate of harvest failure (45%) was disappointingly high, compared with previous reports, possibly because of patient selection or differences in granulocyte-colony stimulating factor (G-CSF) dosage.
Department of Oncology, Lund University Hospital, Sweden. mats.jerkeman@onk.lu.se
M
M
Jerkeman
S
S
Leppä
S
S
Kvaløy
H
H
Holte
D000328:Adult; D000368:Aged; D018952:Antigens, CD34; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use* / Q000633:toxicity; D016190:Carboplatin / Q000008:administration & dosage; D018450:Disease Progression; D005047:Etoposide / Q000008:administration & dosage; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D019650:Hematopoietic Stem Cell Mobilization / Q000592:standards; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D007937:Leukapheresis / Q000592:standards; D008223:Lymphoma / Q000188:drug therapy* / Q000628:therapy; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy / Q000628:therapy; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation; D012008:Recurrence; D012537:Scandinavian and Nordic Countries; D016896:Treatment Outcome
D018952:Antigens, CD34; D016179:Granulocyte Colony-Stimulating Factor; D005047:Etoposide; D016190:Carboplatin; D007069:Ifosfamide