Ifosfamide, gemcitabine, and vinorelbine: a new induction regimen for refractory and relapsed Hodgkin's lymphoma.
OBJECTIVE
Response to pre-transplant salvage chemotherapy remains the most important prognostic factor for outcome in refractory or relapsed Hodgkin's lymphoma. Results of a new induction regimen are reported in terms of response rates, toxicity, and stem cell mobilization.


METHODS
Ninety-one patients with refractory or relapsed Hodgkin's lymphoma were treated prospectively with a salvage regimen consisting of ifosfamide 2000 mg/m2 on days 1 to 4, gemcitabine 800 mg/m2 on days 1 and 4, vinorelbine 20 mg/m2 on day 1, and prednisolone 100 mg on days 1 to 4 (IGEV).


RESULTS
Forty-nine patients (53.8%) achieved a complete remission and 25 (27.5%) a partial response for an overall response rate of 81.3%. In the multivariate analysis response to the last chemotherapy (p<0.0001) and involvement of > or =3 sites (p<0.049) were the most important prognostic factors for response. Adequate CD34+ cell collection was achieved in 78 out of 79 (98.7%) mobilized patients. So far, no treatment-related death has been documented. Thirteen (4.2%) and 27 (8.6%) out of 313 evaluated cycles had to be delayed or reduced, respectively, mainly because of neutropenia and thrombocytopenia. No grade 4 non-hematologic toxicity was observed, except for one episode of mucositis.


CONCLUSIONS
The high response rate, in particular the complete remission rate, the low toxicity profile, and the very high mobilizing potential of the IGEV regimen strongly suggest that patients with relapsed/refractory Hodgkin's lymphoma may benefit from the use of this salvage induction regimen.
Santoro
Armando
A
Department of Medical Oncology and Hematology, Istituto Clinico Humanitas, via Manzoni 56, 20089 Rozzano, Milan, Italy. armando.santoro@humanitas.it
Magagnoli
Massimo
M
Spina
Michele
M
Pinotti
Graziella
G
Siracusano
Licia
L
Michieli
Mariagrazia
M
Nozza
Andrea
A
Sarina
Barbara
B
Morenghi
Emanuela
E
Castagna
Luca
L
Tirelli
Umberto
U
Balzarotti
Monica
M
D000293:Adolescent; D000328:Adult; D018952:Antigens, CD34 / Q000096:biosynthesis; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D005260:Female; D006689:Hodgkin Disease / Q000188:drug therapy*; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D033581:Stem Cell Transplantation; D016896:Treatment Outcome; D014747:Vinblastine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000077235:Vinorelbine; D000093542:Gemcitabine
D018952:Antigens, CD34; D003841:Deoxycytidine; D014747:Vinblastine; D000077235:Vinorelbine; D007069:Ifosfamide; D000093542:Gemcitabine