Effective salvage chemotherapy in relapsed or refractory non-Hodgkin's lymphoma

Over the last few years, high-dose chemotherapy has been extensively investigated in relapsing/refractory non-Hodgkin's lymphoma (NHL). However, this approach is reserved to a limited subset of cases and new conventional-dose second-line chemotherapies need to be investigated.

Thirty consecutive out-patients with refractory or recurrent NHL were given polychemotherapy in a regimen consisting of ifosfamide, mitoxantrone and etoposide on day 1 and vindesine, cisplatinum and cytosine arabinoside on day 15: courses were repeated every 29 days. Five patients had refractory disease following first-line chemotherapy and 25 were relapsing.

The median number of administered cycles was 4 (range 2-8). We observed 16 complete (53%; 95% confidence interval, 34%-72%) and 3 partial remissions, for an overall remission rate of 63% (95% confidence interval, 44%-80%). Responses were seen only among patients who achieved at least a partial response during first-line therapy. The median duration of complete remission was 15 months (range 5-47+), whereas median survival of the treated patients was 26 months (range 2-50+). Five patients were long-term responders after 34+, 35+, 46+, 46+ and 47+ months. No-life threatening toxicity was observed. The main side effects were myelosuppression, nausea/vomiting and alopecia.

The proposed regimen is feasible and effective in terms of complete remission rate and disease-free survival, suggesting that this treatment may be potentially curative in a subgroup of relapsed patients with limited tumor burden and normal LDH values. A more aggressive approach is needed in refractory patients.