DIZE (dexamethasone, idarubicin, and continuous infusion of ifosfamide andetoposide): An effective and well-tolerated new regimen for patients with relapsed lymphoma

We performed a phase II study of dexamethasone, ifosfamide, idarubicin and etoposide (DIZE) in patients with relapsed or refractory Hodgkin's (I-IL) a nd non-Hodgkin's lymphoma (NHL). The regimen consisted of dexamethasone (20 mg i.v. days 1-4), idarubicin (8 mg/m(2) i.v. days 1+2), continuous infusi on (c.i.) of ifosfamide (1,000 mg/m(2) days 1-4), and c.i. etoposide (60 mg /m(2) days 1-4). G-CSF (5 mu g/kg) was used to support neutrophil recovery from day 5. In older patients (> 60 years) the dosage of idarubicin and ifo sfamide was reduced to 75 % in the initial cycle. Fourty six patients (pts) were treated with a total of 131 cycles. Sixteen pts were primary resistan t and 30 were relapsed. Median age was 54.3 years (range 22-75). The median number of different prior chemotherapies was 1.7 (range I to 5). 31/46 (67 .4 %) pts had advanced disease (stage III or TV); 19/46 had B symptoms. Of 43 evaluable pts the response rate was 58.1% including 11 complete remis sions (CR) and 14 partial remissions (PR). Mean duration of response was 8 months (1-30+). DIZE was more effective in relapsed than in refractory high -grade NHL (74 % vs 16.6 %; p < 0.001). Of four heavily pretreated pts with HL, one obtained CR and two PR (response rate 75 %). Myelosuppression was generally moderate with a mean duration of leukocytopenia < 1,0001/mu l of 2.5 days (range 0-18) and of thrombocytopenia < 25,000/mu l 1.5 days (range 0-17). One patient died of uncontrollable infection in treatment related n eutropenia. No other serious toxicities apart from alopecia were observed. We conclude that DIZE is safe and effective in heavily pretreated pts with relapsed lymphoma. The continuous infusion of cytostatic drugs such as that used in the new DIZE protocol might reduce hematotoxicity.