title: Efficacy of high-dose methotrexate, ifosfamide, etoposide and dexamethasone salvage therapy for recurrent or refractory childhood malignant lymphoma.
abstract: BACKGROUND
  Children with recurrent or refractory malignant lymphoma generally have a poor prognosis. There is a need for new active drug combinations for this high-risk group of patients.
  
  
  METHODS
  This study evaluated the activity and toxicity of the methotrexate, ifosfamide, etoposide and dexamethasone (MIED) regimen for childhood refractory/recurrent non-Hodgkin's lymphoma (NHL) or Hodgkin's lymphoma (HL). From 1991 through 2006, 62 children with refractory/recurrent NHL (n = 24) or HL (n = 38) received one to six cycles of MIED. Based on MIED response, intensification with hematopoietic stem cell transplantation (HSCT) was considered.
  
  
  RESULTS
  There were 10 complete (CR) and 5 partial responses (PR) among the 24 children with NHL [combined response rate, 63%; 95% confidence interval (CI) 38% to 73%]. There were 13 CR and 18 PR among the 37 assessable children with HL (combined response rate, 84%; 95% CI, 68% to 94%). Although 59% courses were associated with grade IV neutropenia, treatment was well tolerated and without toxic deaths.
  
  
  CONCLUSIONS
  MIED is an effective regimen for refractory/recurrent childhood malignant lymphoma, permitting a bridge to intensification therapy with HSCT.
authors.affiliation: Department of Oncology, St Jude Children's Research Hospital, University of Tennessee, Memphis, TN, USA. John.Sandlund@stjude.org
authors.forename: J T
authors.initials: JT
authors.lastname: Sandlund
authors.forename: C-H
authors.initials: CH
authors.lastname: Pui
authors.forename: H
authors.initials: H
authors.lastname: Mahmoud
authors.forename: Y
authors.initials: Y
authors.lastname: Zhou
authors.forename: E
authors.initials: E
authors.lastname: Lowe
authors.forename: S
authors.initials: S
authors.lastname: Kaste
authors.forename: L E
authors.initials: LE
authors.lastname: Kun
authors.forename: M J
authors.initials: MJ
authors.lastname: Krasin
authors.forename: M
authors.initials: M
authors.lastname: Onciu
authors.forename: F G
authors.initials: FG
authors.lastname: Behm
authors.forename: R C
authors.initials: RC
authors.lastname: Ribeiro
authors.forename: B I
authors.initials: BI
authors.lastname: Razzouk
authors.forename: S C
authors.initials: SC
authors.lastname: Howard
authors.forename: M L
authors.initials: ML
authors.lastname: Metzger
authors.forename: G A
authors.initials: GA
authors.lastname: Hale
authors.forename: R
authors.initials: R
authors.lastname: Rencher
authors.forename: K
authors.initials: K
authors.lastname: Graham
authors.forename: M M
authors.initials: MM
authors.lastname: Hudson
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D003907:Dexamethasone / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D006689:Hodgkin Disease / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy* / Q000473:pathology; D008727:Methotrexate / Q000008:administration & dosage; D012008:Recurrence; D016879:Salvage Therapy
chemical_list: D005047:Etoposide; D003907:Dexamethasone; D007069:Ifosfamide; D008727:Methotrexate