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European experience with ifosfamide in lymphomas
A K von Kalle1, M Schaadt, V Diehl
1Med. Klinik I, Universität Köln, FRG.
Seminars in Oncology
|February 1, 1989
Summary
Ifosfamide-containing regimens show promise in treating malignant lymphomas, including non-Hodgkin
Area of Science:
- Oncology
- Hematology
- Pharmacology
Background:
- Ifosfamide-containing regimens were initially used in second-line and response-adapted therapies for malignant lymphomas.
- Current research explores ifosfamide in combination with other drugs within phase-III trials for lymphoma treatment.
- Conventional chemotherapy resistance and relapse are significant challenges in treating Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL).
Purpose of the Study:
- To evaluate the efficacy of ifosfamide-based salvage therapies in non-Hodgkin's lymphoma (NHL).
- To assess the role of consolidation therapy in achieving complete remission (CR) in high-grade malignant lymphoma.
- To investigate novel ifosfamide-containing regimens as alternatives for refractory Hodgkin's disease (HD) and NHL.
Main Methods:
- Treatment protocols included IMV-Bleo (ifosfamide, methotrexate, etoposide, bleomycin) and IBEP (ifosfamide, bleomycin, etoposide, procarbazine) for NHL.
- Response-oriented therapy involved COP-BLAM (cyclophosphamide, vincristine, procarbazine, prednisone, bleomycin, doxorubicin) followed by IMV (ifosfamide, methotrexate, etoposide) consolidation.
- BMV-VIP (bleomycin, methylprednisolone, ifosfamide, etoposide) was used for refractory HD and NHL. IMEP (ifosfamide, methotrexate, etoposide, prednisone) was added to COPP/ABV for HD.
Main Results:
- IMV-Bleo achieved a 41% complete remission (CR) rate in NHL, particularly effective in patients with suboptimal first-line response.
- IBEP demonstrated efficacy as a non-cross-resistant alternative for CHOP-refractory NHL.
- In high-grade NHL, COP-BLAM followed by IMV consolidation led to 61% CR after second restaging. 47% of partial responders achieved CR with IMV.
- A pilot study of IMEP in HD primary treatment reported an 87% CR rate in evaluable patients.
Conclusions:
- Ifosfamide-containing regimens are effective salvage therapies for refractory and relapsed lymphomas.
- Consolidation therapy, including ifosfamide-based regimens, is crucial for achieving durable remissions in high-grade lymphomas.
- Novel ifosfamide combinations like IMEP show significant promise in the primary treatment of Hodgkin's disease.