High-dose cytarabine and mitoxantrone as salvage therapy for refractory non-Hodgkin's lymphoma

High-dose cytarabine (ara-C) alone or in combination with mitoxantrone each has shown to be active in therapeutic trials of refractory non-Hodgkin's lymphoma (NHL). In this study, we administered these two drugs to 14 patients with advanced and refractory NHL.

Ara-C was administered at a dosage of 3 gm/sqm for 2-hour intravenous infusion every 12 hours from day 1 to day 4 (8 doses), and mitoxantrone was given at a dosage of 6 mg/sqm/day for 1-hour intravenous infusion from day 1 to day 5. The clinical efficacy and toxicity were assessed by WH0 criteria.

Four patients (28%) attained complete remission (CR) and 2 had partial remission (PR). Of the 4 CR patients, the remission lasted 5 months in one patient and 4 months in another. The remaining 2 patients had CR of only 1.3 months. Myelosup-pression with subsequent infection was the major toxicity of this regimen. Severe neutropenia (<1,000/uL) lasted for an average of 20 days, and thrombocytopenia (<50,000/uL) 24 days. Nonmyeloid toxicities included 100% alopecia, 93% stomatitis, 43% hepatotoxicity, 36% dermatitis, 28% CNS toxicity and 7% chemical conjunctivitis.

A proportion of refractory NHL patients will respond to high-dose ara-C + mitoxantrone, despite that severe myelosuppression is frequently encountered.