Ma. Rodriguez et al., RESULTS OF A SALVAGE TREATMENT PROGRAM FOR RELAPSING LYMPHOMA - MINE CONSOLIDATED WITH ESHAP, Journal of clinical oncology, 13(7), 1995, pp. 1734-1741
Purpose: We report the results of a prospective trial in which patient
s with relapsing non-Hodgkin's lymphomas were sequentially treated wit
h two regimens (mesna, ifosfamide, mitoxantrone, and etoposide [MINE],
and etoposide, methylprednisolone, cytarabine, and cisplatin [ESHAP])
if they had no history of disease resistance to these drugs. Patients
and Methods: Ninety-two patients received MINE (mesna 4 g/m(2), ifosf
amide 4 g/m(2), mitoxantrone 8 mg/m(2), and etoposide 195 mg/m(2)) for
a maximum of six courses followed by ESHAP (etoposide 240 mg/m(2), me
thylprednisone 500 mg/d, high-dose cytarabine 2 g/m(2), and cisplatin
100 mg/m(2)) for three courses to consolidate complete response (CR) o
r for a maximum of six cycles after a partial response (PR) or no resp
onse to MINE. pretreatment serum levels of lactate dehydrogenase (LDH)
and beta(2)-microglobulin (beta(2)M) were documented in 80 of 92 pati
ents. Results: the response rate to MINE-ESHAP was 69% (48% CRs and 21
% PRs), with a median survival time of 24 months and median time to tr
eatment failure of 12 months. The median time to treatment failure acc
ording to histology was as follows: low-grade histologies, 16 months;
low-grade transformed to intermediate-grade, 8 months; and intermediat
e-grade, 5 months, The most serious complication was myelosuppression,
which resulted in two deaths due to neutropenic sepsis. A risk factor
model based on beta(2)M and LDH levels before salvage treatment showe
d three categories of risk, with 36-month survival rates os follows: l
ow (beta(2)M < 3 mg/dL and LDH normal), 61%; intermediate (beta(2)M gr
eater than or equal to 3 mg/dL or LDH above normal), 23%; and high (be
ta(2)M greater than or equal to 3 mg/dL and LDH above normal), 0%. Con
clusion: MINE-ESHAP is an effective salvage strategy for patients with
recurrent lymphoma. Toxicity was acceptable. Factors that determine p
rognostic categories at relapse merit further study.