Ifosfamide, epirubicin and etoposide regimen as salvage and mobilizing therapy for relapsed/refractory lymphoma patients

• Published in: Haematologica (Roma) Vol. 87; no. 8; pp. 816 - 821
• Main Authors: Zinzani, PL, Tani, M, Molinari, AL, Stefoni, V, Zuffa, E, Alinari, L, Gabriele, A, Bonifazi, F, Salvucci, M, Tura, S, Baccarani, M
• Format: Journal Article
• Language: English
• Published: Pavia Haematologica 01.08.2002
• Subjects: Adolescent; Adult; Antineoplastic agents; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Bone Marrow Transplantation; Chemotherapy; Combined Modality Therapy; Disease-Free Survival; Epirubicin - administration & dosage; Etoposide - administration & dosage; Female; Follow-Up Studies; Hematopoietic Stem Cell Mobilization; Humans; Ifosfamide - administration & dosage; Lymphoma - drug therapy; Lymphoma - mortality; Lymphoma - therapy; Lymphoma, Non-Hodgkin - drug therapy; Lymphoma, Non-Hodgkin - mortality; Lymphoma, Non-Hodgkin - therapy; Male; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Prognosis; Recurrence; Remission Induction; Salvage Therapy; Stem Cell Transplantation; Transplantation, Autologous; Treatment Outcome; Antineoplastic agent; Relapse; Stem cell; Hematopoietic cell; Antihormone; Autograft; Isomerases; Lymphoproliferative syndrome; Bone marrow; Graft; Evolution; Malignant lymphoma; Remission; Epirubicin; Antimitotic; Human; DNA topoisomerase (ATP-hydrolysing); Enzyme; Ifosfamide; Enzyme inhibitor; Etoposide; Malignant hemopathy; Podophyllotoxine derivatives; Refractory; Antibiotic; Alkylating agent; Chemotherapy; Oxazaphosphinane derivatives; Treatment; Nitrogen mustard; Anthracyclins; Therapeutic protocol
• ISSN: 0390-6078; 1592-8721

Istituto di Ematologia e Oncologia Medica L. e A. Seragnoli, Policlinico S.Orsola, via Massarenti 9, 40138 Bologna, Italy. plzinzo@med.unibo.it BACKGROUND AND OBJECTIVES: Therapy for relapsed/refractory lymphomas should be based only on drugs not included in the front-line chemotherapy regimens. We adopted the strategy of using salvage chemotherapy to debulk disease and simultaneously mobilize stem cells, using a regimen based on ifosfamide and etoposide, (drugs not usually used for front-line treatment). DESIGN AND METHODS: A three-drug combination of ifosfamide, epirubicin and etoposide (IEV) was used to treat 62 patients with relapsing or refractory aggressive non-Hodgkin's lymphoma (NHL; n=51) or Hodgkin's disease (HD; n=11). Forty-five of the patients were studied for the feasibility of peripheral blood stem cell (PBSC) harvest. RESULTS: The overall and complete response (CR) rates were, respectively, 77% and 32% in the NHL subset and 81% and 45% in the HD subset. Among the 17 patients who achieved CR after IEV but did not have a subsequent transplantation, the median duration of the response was 9 months (range, 2 to 14 months). Mobilization was successful in 33 of 45 (71%) patients. Among the 45 who proceeded to autotransplantation, 27 (60%) were in CR status after the autograft; 23/45 (51%) patients are currently in continuous CR with a median follow-up of 25 months (range, 10-68 months); the relapse-free survival curve shows 83% in this state at 60 months. Twenty-three (37%) patients are currently in continuous CR with a median follow-up of 25 months. Clinical and hematologic toxic effects were mild. INTERPRETATION AND CONCLUSIONS: Our results indicate the efficacy of the IEV regimen in inducing a good remission rate. IEV is a predictable and highly effective mobilization regimen in relapsed/refractory patients with aggressive NHL or HD.