Augmented ICE in Patients With Poor-Risk Refractory and Relapsed Lymphomas

Area of Science:

• Hematology
• Oncology
• Stem Cell Transplantation

Background:

• Salvage chemotherapy sensitivity is crucial for outcomes in relapsed/refractory lymphoma patients awaiting autologous stem cell transplant.
• Conventional dose ifosfamide, carboplatin, and etoposide (ICE) shows limited efficacy in patients with early relapse or primary refractory disease.
• Augmented ICE offers a dose-intensified approach to improve outcomes in this challenging patient population.

Purpose of the Study:

• To evaluate the response, deliverability, toxicities, and outcomes of augmented ICE in transplant-eligible patients with relapsed/refractory diffuse large-B-cell lymphoma (DLBCL) or Hodgkin lymphoma (HL).

Main Methods:

• Retrospective evaluation of 21 patients (13 DLBCL, 8 HL) receiving augmented ICE between 2010-2020.
• Augmented ICE involved higher doses of ifosfamide (10 g/m²) and etoposide (600 mg/m²) compared to standard ICE.
• Patients achieving complete or partial response proceeded to autologous stem cell transplant.

Main Results:

• High overall response rates: 85% for DLBCL and 100% for HL.
• 19 of 21 patients completed 2 cycles; 18 proceeded to transplant.
• Significant toxicities included febrile neutropenia (86%) and reversible ifosfamide encephalopathy (2 patients).
• 5-year OS/PFS: DLBCL (62%/45%), HL (100%/88%).

Conclusions:

• Augmented ICE demonstrates a high response rate and facilitates transplant realization in relapsed/refractory lymphoma.
• The intensified regimen comes at the cost of increased toxicity, requiring careful management.
• This approach offers a viable option for improving outcomes in select lymphoma patients.