New perspectives in the treatment of non-Hodgkin's lymphoma

Curability of patients with advanced intermediate- or high-grade non-Hodgkin's lymphoma using front-line anthracycline-containing chemotherapy remains disappointingly low. Novel regimens used as salvage therapy for these patients continue to be explored. Ifosfamide has been shown to have significant single-agent activity against non-Hodgkin's lymphoma and its use in various combinations produces response rates of 20% to 83% in patients with refractory or relapsing disease. In our study of 32 evaluable patients using dexamethasone/ifosfamide/cisplatin/etoposide as salvage treatment, seven patients (22%) achieved a complete response and 15 (47%) had a partial response, for an overall response rate of 69%. Median duration of response is substantial for patients who achieve a complete response (18+ months), and dexamethasone/ifosfamide/cisplatin/etoposide produces useful palliation in some patients who attain a partial response (16+ months). Gastrointestinal side effects are minimal, with myelosuppression being the dose-limiting toxicity. Ifosfamide-containing regimens have now been incorporated either as response-adapted consolidation to front-line therapy or integrated with standard front-line treatment. We have divided our patient population by age and are investigating prednisone/etoposide/mitoxantrone as front-line therapy for patients older than 65 years. Patients younger than 65 are now being entered into a front-line, response-adapted, ifosfamide-containing chemotherapy regimen with a view to enhancing their curability.