DICE (DEXAMETHASONE, IFOSFAMIDE, CISPLATIN, ETOPOSIDE) AS SALVAGE THERAPY IN NON-HODGKINS-LYMPHOMAS

Between April 1988 and April 1992 we conducted a study of DICE (dexame thasone IO mg q6h, ifos-famide 1 g/m(2), cisplatin 25 mg/m(2), etoposi de 100 mg/m(2), and mesna uroprotection daily x 4 given every 28 days) in thirty six patients with intermediate or high-grade non-Hodgkin's lymphomas (NHL's), All patients had disease refractory to anthracyclin e-based chemotherapy and were ineligible for our dose intensive salvag e chemotherapy program including autologous bone marrow transplant (AB MT). Twenty six men and 10 women aged 21-79 years (median 61) were giv en 100 courses of treatment in hospital. Twenty three patients had sta ge IV, 7 stage III and 6 stage II disease. Fourteen patients had bone marrow involvement and II had B symptoms. Thirty two patients had rece ived only 1 previous chemotherapy regimen. After a follow-up of 1-70 m onths (median 7), 8 of the 34 (23%) patients evaluable for response ha d complete remission (CR) of their disease for 8-70+ months (med 24) a nd 15/34 (44%) partial remission (PR) for 2-55+ months (med 13), givin g an overall response rate of 67% (23/34). Eight of the 36 patients ar e alive 34-70 months (median 48) after being enrolled on study, 6 of w hom relapsed and responded to subsequent treatment. The estimated surv ival rates for all patients at 1 and 2 years are 50% and 36% respectiv ely (Kaplan Meier). Response to prior chemotherapy was the only baseli ne characteristic statistically predictive (p = 0.04) of response to D ICE by logistic regression analy sis. Myelosuppression was the dose li miting toxicity. Two patients (5.5%) died from treatment induced sepsi s. Fifteen (42%) patients developed a granulocyte nadir of < 0.5 x 10( 9)/L. and 15 (42%) patients developed a platelet nadir of < 50 x 10(9) /L. Nine patients required RBC transfusions and 8, platelet transfusio ns. Non-hematologic toxicity, in particular GI toxicity, was extremely mild, with 13/36 patients experiencing no toxicity and only 2/36 havi ng grade III toxicity. No episodes of gross hematuria occurred and one patient developed an episode of transient blurred vision and delirium that resolved spontaneously. In summary, DICE is an active regimen in refractory NHL's. It is a particularly well tolerated alternative for patients failing to meet the criteria for autologous bone marrow tran splant (ABMT) by virtue of age or other adverse prognostic factors. My elosuppression is dose limiting and higher doses with hematopoietic gr owth factors merit testing either alone or in combination with ABMT, I ncorporation of DICE into front-line regimens for high risk patients s hould be considered.