title: Ifosfamide, epirubicin and etoposide (IEV) regimen as salvage and mobilization therapy for refractory or early relapsing patients with aggressive non-Hodgkin's lymphoma.
abstract: The prognosis of early relapsing or refractory aggressive non-Hodgkin's lymphoma (NHL) is still poor. Effective salvage therapy should be able to induce high response rate as well as to mobilize hematopoietic precursors. A combination of ifosfamide, epirubicin and etoposide (IEV) was given to 28 patients with refractory or relapsing high grade NHL (4 lymphoblastic lymphoma and 24 large cell lymphoma). All patients were evaluated for response. After 2 courses of IEV, the overall and complete response rate were 64% and 39%, respectively. All patients were controlled for mobilization of peripheral blood stem cells, which was successful in 26 out of 28 (93%). Overall, 25 out of 26 patients proceeded to autologous stem cell transplantation (ASCT). Toxicity was mild, with no occurrence of severe persisting extra-hematologic side-effects. Following the entire therapeutic program, including IEV and ASCT, median progression free survival has not yet been reached and 21 patients are alive (18 in continuous complete remission) after a median follow-up of 18 months. Our results demonstrate that treatment with IEV regimen is effective in refractory or relapsing aggressive NHL, resulting in a high percentage of successful stem cell mobilization and feasibility of ASCT.
authors.affiliation: Division of Hematology and Stem Cell Transplantation Unit, Cardarelli Hospital, Napoli, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Pocali
authors.forename: Mariacarla
authors.initials: M
authors.lastname: De Simone
authors.forename: Mario
authors.initials: M
authors.lastname: Annunziata
authors.forename: Salvatore
authors.initials: S
authors.lastname: Palmieri
authors.forename: Maria Rosaria
authors.initials: MR
authors.lastname: D'Amico
authors.forename: Carolina
authors.initials: C
authors.lastname: Copia
authors.forename: Assunta
authors.initials: A
authors.lastname: Viola
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Mele
authors.forename: Ettore Mariano
authors.initials: EM
authors.lastname: Schiavone
authors.forename: Felicetto
authors.initials: F
authors.lastname: Ferrara
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D018572:Disease-Free Survival; D015251:Epirubicin / Q000627:therapeutic use*; D005047:Etoposide / Q000627:therapeutic use*; D005260:Female; D019650:Hematopoietic Stem Cell Mobilization; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007069:Ifosfamide / Q000627:therapeutic use*; D016403:Lymphoma, Large B-Cell, Diffuse / Q000628:therapy; D008228:Lymphoma, Non-Hodgkin / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy; D012074:Remission Induction; D016879:Salvage Therapy; D014182:Transplantation, Autologous; D016896:Treatment Outcome
chemical_list: D015251:Epirubicin; D005047:Etoposide; D007069:Ifosfamide