title: Salvage chemotherapy with dexamethasone, etoposide, ifosfamide and cisplatin (DVIP) for relapsing and refractory non-Hodgkin's lymphoma.
abstract: BACKGROUND
  There is currently no standard salvage chemotherapy for the 40-50% of patients with non-Hodgkin's lymphoma who fail first-line treatment.
  
  
  OBJECTIVE
  To review the experience of a major tertiary medical center with DVIP (dexamethasone, etoposide, ifosfamide and cisplatin) salvage therapy for primary refractory/relapsing NHL.
  
  
  METHODS
  We reviewed the records of all patients with NHL who received DVIP salvage therapy during the period 1993 to 2005.
  
  
  RESULTS
  We identified 37 adult patients (mean age 56.3 years): 29 with aggressive lymphoma and 8 with indolent lymphoma. Mean event-free survival was 13.5 months (range 0-82 months), mean time between diagnosis and DVIP treatment 18.5 months (range 2-101), and mean number of DVIP cycles 1.9. Four patients (11%) achieved a complete response and 9 (24%) a partial response (overall response 35%). Consolidation with stem cell transplantation was used in 14 patients with aggressive lymphoma and 4 with indolent lymphoma; 14 patients, all with aggressive lymphoma, responded (12 complete, 2 partial). Of the 10 patients who underwent SCT despite no response to salvage DVIP, 6 achieved a complete response. Five year overall survival since the diagnosis for the whole sample was 39.4 +/- 8.7%, and 5 year post-DVIP overall survival 37.6 +/- 8.0%. On multivariate analysis, SCT was the strongest predictor of survival (relative risk 0.73, P < 0.0001) followed by a high score on the International Prognostic Index (RR 3.71, P = 0.032).
  
  
  CONCLUSIONS
  DVIP salvage therapy for NHL was associated with a low response rate of 35% but a 5 year post-DVIP survival rate of 37.6%. Patients who are refractory to salvage treatment with DVIP might still be salvaged with SCT.
authors.affiliation: Institute of Hematology, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel.
authors.forename: Ariela Dortort
authors.initials: AD
authors.lastname: Lazar
authors.forename: Ofer
authors.initials: O
authors.lastname: Shpilberg
authors.forename: Mati
authors.initials: M
authors.lastname: Shaklai
authors.forename: Osnat
authors.initials: O
authors.lastname: Bairey