High-dose ifosfamide and mitoxantrone (HDIM) in patients with relapsed or refractory Hodgkin's lymphoma.
Relapsed/refractory Hodgkin's lymphoma (HL) is treated with salvage chemotherapy and autologous stem cell transplantation (ASCT). Optimal chemotherapy is unknown. We retrospectively analyzed outcomes of 58 patients treated with 2 cycles of high-dose ifosfamide and mitoxantrone (HDIM). HDIM consisted of ifosfamide 5 g/m(2)/day and MESNA 5 g/m(2)/day in continuous 24-h infusion (days 1 and 2), MESNA 2.5 g/m(2) over 12 h (day 3), and mitoxantrone 20 mg/m(2) (day 1) administered every 2 weeks. Stem cells were collected after the first cycle. Responding patients proceeded to ASCT. Toxicity was acceptable. Stem cell mobilization was successful in 96 % of patients. Overall response rate was 74 % (89 % in relapsing and 45 % in refractory patients) with 31 % complete remissions. After a median follow-up of 54 months, 5-year event-free survival was 56 % (69 % for relapsing and 35 % for refractory patients), and 5-year overall survival was 67 % (73 % for relapsing and 55 % for refractory patients). Significant adverse prognostic factors were refractoriness to previous therapy and HDIM failure. No differences in outcomes were noted between patients with early and late relapses or between complete and partial responders. HDIM is a well-tolerated and effective regimen for relapsed and refractory HL with excellent stem cell mobilizing properties. Patients failing HDIM may still benefit from other salvage options.
Division of Hematology, Department of Internal Medicine, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia. aurer@mef.hr.|Medical School, University of Zagreb, Zagreb, Croatia. aurer@mef.hr.
Igor
I
Aurer
Division of Hematology, Department of Internal Medicine, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia.|Medical School, University of Zagreb, Zagreb, Croatia.
Damir
D
Nemet
Medical School, University of Zagreb, Zagreb, Croatia.
Zdravko
Z
Mitrović
Medical School, University of Zagreb, Zagreb, Croatia.
Dino
D
Dujmović
Division of Hematology, Department of Internal Medicine, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia.
Sandra
S
Bašić-Kinda
Division of Hematology, Department of Internal Medicine, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia.
Ivo
I
Radman
Division of Hematology, Department of Internal Medicine, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia.
Dubravka
D
Sertić
Medical School, University of Zagreb, Zagreb, Croatia.|Department of Oncology, University Hospital Centre Zagreb, Zagreb, Croatia.
Fedor
F
Šantek
Department of Radiology, University Hospital Centre Zagreb, Zagreb, Croatia.
Marko
M
Kralik
Department of Pathology and Cytology, University Hospital Centre Zagreb, Zagreb, Croatia.
Snježana
S
Dotlić
Department of Transfusion Medicine, University Hospital Centre Zagreb, Zagreb, Croatia.
Sanja
S
Mazić
Division of Hematology, Department of Internal Medicine, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia.|Medical School, University of Zagreb, Zagreb, Croatia.
Boris
B
Labar
D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods; D006689:Hodgkin Disease / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D008942:Mitoxantrone / Q000008:administration & dosage*; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000628:therapy*; D012189:Retrospective Studies; D014182:Transplantation, Autologous; D055815:Young Adult
D008942:Mitoxantrone; D007069:Ifosfamide
Antineoplastic combined chemotherapy protocols; Autologous stem cell transplantation; Hodgkin’s lymphoma; Ifosfamide; Mitoxantrone