• Antonio Salar, Rodrigo Martino, Granada Perea, José María Ribera, Armando López-Guillermo, Ramón Guardia, Lourdes Escoda, Albert Altés, Jorge Sierra, and Emili Montserrat.
• Department of Clinical Hematology from Hospital del Mar, Hospital de la Santa Cruz y San Pablo, Hospital Germans Trias i Pujol, Hospital Clínic, Barcelona, Spain. asalar@imas.imim.es
• Haematologica. 2002 Oct 1; 87 (10): 1028-35.

Background And ObjectivesA salvage program including infusional high-dose ifosfamide plus etoposide (IFOVM) was evaluated in patients with refractory or relapsed aggressive non-Hodgkin's lymphoma.Design And MethodsForty-six patients were included. IFOVM consisted of ifosfamide (10 g/m2 as a 72-hour continuous infusion), etoposide (900 mg/m2) and methylprednisolone; responding patients underwent two cycles of DHAP and subsequently an autologous peripheral blood stem cell transplantation (APBSCT) with BEAM as the conditioning regimen.ResultsAll but one patient showed tumor regression following IFOVM. Myelosuppression was brief but 26 patients developed neutropenic fever. All but two patients proceeded to DHAP. Overall response rate to IFOVM/DHAP was 59% (29% CR and 30% PR). Refractory patients had a significantly lower response rate than relapsed patients (39% vs. 85% p=0.002). All refractory patients with intermediate-high or high IPI progressed during IFOVM/DHAP. Twenty-seven patients proceeded to APBSCT. Two-year overall survival of patients with low or low-intermediate IPI was 47% [95% CI 25-69%], which was significantly better than that obtained in patients with intermediate-high or high IPI (11% [95% CI 0-22%] p=0.0001).Interpretation And ConclusionsThis sequential regimen of IFOVM, followed by DHAP and consolidated with BEAM is active in relapsed or refractory patients with low or low-intermediate IPI aggressive lymphoma. However, it has little activity in those patients with intermediate or high IPI, especially in refractory lymphomas.

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