Ifosfamide and etoposide-based chemotherapy as salvage and mobilizing regimens for poor prognosis lymphoma

Abstract

We treated 40 patients with poor prognosis lymphomas. Patients with non-Hodgkin’s lymphoma (NHL, n = 14) received MINE chemotherapy (mesna, ifosfamide 1330 mg/m² and etoposide 65 mg/m² by i.v. infusions on days 1–3, mitoxantrone 8 mg/m² i.v. on day 1), and those with Hodgkin’s disease (HD, n = 26) received VIM chemotherapy (mesna, ifosfamide 1200 mg/m² by i.v. infusion on days 1–5, etoposide 90 mg/m² by i.v. infusion on days 1, 3 and 5, and methotrexate 30 mg/m² i.v. on days 1 and 5). Chemotherapy was followed by G-CSF (10 or 16 μg/kg in two divided doses daily) to mobilize PBSC. We performed 134 aphereses (median three leukaphereses per patient) starting on either day 13 (median; VIM) or day 12 (median; MINE). The median yield was 9.9 × 10⁶ CD34⁺ cells/kg and 53.2 × 10⁴ CFU-GM/kg for VIM, and 13.5 × 10⁶ CD34⁺ cells/kg and 53.4 × 10⁴ CFU-GM/kg for MINE. Except for predictable myelosuppression, no serious toxicity was seen. Response rate using MINE was 63% (18% CR, 45% PR) and using VIM 50% (17% CR, 33% PR). We conclude that VIM and MINE are effective and well-tolerated salvage regimens in patients with lymphomas and, followed by G-CSF, they also exhibit good capacity to mobilize stem cells in a predictable time interval.