Modified Magrath IVAC regimen as second-line therapy for relapsed or refractory aggressive non-Hodgkin's lymphoma in developing countries: the experience of a single center in Brazil.
BACKGROUND
The purpose of this retrospective study was to investigate the efficacy, toxicity and mobilization rate after modified Magrath IVAC (mIVAC) chemotherapy regimen prescribed in relapsed disease (RD) or primary refractory disease (PRD) in aggressive non-Hodgkin lymphoma (NHL).


METHODS
Twenty-four patients (16 males, 8 females) aged 18-59 years (median age 37 year) were analyzed. The most frequent histopathological subgroup was diffuse large B-cell lymphoma (DLCL-B) (n=21/24), 13 (54%) were considered RD and 11 (46%) PRD. The mIVAC consisted of ifosfamide (IFM), high dose cytarabine and etoposide repeated every 28 days.


RESULTS
The overall response (OR) after three cycles of mIVAC was 66. 6%. Among the patients with PRD, OR was 45.5% (5 out of 11) and with RD was 86.4%, p>0.05, however, it was observed in RD better complete response (CR) than PRD 53.8x9.1% (p<0.05). Eighty-eight percent (14 out of 16) of patients with chemosensitive disease to mIVAC underwent autologous stem cell transplantation (ASCT). The median number of collected CD34+ cells was 2.86x10(6) (range 2.17x10(6) to 4.9x10(6)). The median overall survival rate (OS) for chemosensitive to mIVAC was 16.3 months, with a median follow-up of 16 months. Grades III-IV neutropenia was observed in 85.6% per cycles and grades III-IV thrombocytopenia in 87.5%. Grades III-IV febrile neutropenia was the most common nonhematological toxicity, it occurred in 28% of the cycles and no deaths by toxicity were observed.


CONCLUSIONS
Although a statistic comparative study was not carried out for these 24 patients, the rate of OR to mIVAC was alike the other second-line infusion regimens. The mobilization failure rate was 57.1% and it was similar to other regimens with high dose cytarabine, but it did not limit performed ASCT.
Pereira
Juliana
J
Hematology Department of the Clinic Hospital of the University of São Paulo, Brazil.
Bellesso
Marcelo
M
Pracchia
Luis Fernando
LF
Neto
Abrahão Elias Hallack
AE
Beitler
Beatriz
B
de Almeida Macedo
Maria Cristina Martins
MC
Dias
Lucia Cristina Santos
LC
Dorlhiac-Llacer
Pedro Enrique
PE
Dulley
Frederico Luiz
FL
Chamone
Dalton
D
D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D001938:Brazil; D003561:Cytarabine / Q000008:administration & dosage; D003906:Developing Countries; D018572:Disease-Free Survival; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D016393:Lymphoma, B-Cell / Q000517:prevention & control*; D008228:Lymphoma, Non-Hodgkin / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D033581:Stem Cell Transplantation; D014182:Transplantation, Autologous
D003561:Cytarabine; D005047:Etoposide; D007069:Ifosfamide