Dexamethasone, cytarabine, ifosfamide, and cisplatin as salvage therapy innon-Hodgkin lymphoma

The authors conducted a phase II study to evaluate a new combination of che motherapeutic drugs that includes dexamethasone, cytarabine, ifosfamide, an d cisplatin as salvage therapy in non-Hodgkin lymphoma after prior exposure to both adriamycin and etoposide. All drugs were administered intravenousl y over 4 consecutive days. The daily dose of dexamethasone was 20 mg twice daily. The maximal daily doses of cytarabine, ifosfamide, and cisplatin wer e 75 mg/m(2), 1,200 mg/m(2), and 20 mg/m(2), respectively. Cycles were repe ated every 3 weeks. A total of 31 patients were entered in the trial. Thirt y patients were evaluable for response. A complete response was seen in 11 patients (37%), and a partial response was noted in six patients (20%). A s ignificantly higher complete response rate was seen in patients with relaps ing non-Hodgkin lymphoma compared with those who failed to achieve a comple te response with the last chemotherapy (10/14 vs. 1/16; p < 0.013). A compl ete response continues in two patients who received consolidation with high -dose chemotherapy for more than 49 months and more than 60 months for each patient. Median time to treatment failure and median survival were 3.3 mon ths and 7.5 months, respectively, for the entire group and II months and 30 months, respectively, for complete responders. My elosuppression was prono unced but was usually of short duration. Neutropenic fever developed in 13 patients (42%) and in 15 of 96 cycles (16%). Platelet transfusions were req uired in seven patients (23%). There was one drug-related death associated with myelotoxicity. Nonhematologic toxicity was not dose limiting. The auth ors conclude that dexamethasone, cytarabine, ifosfamide, and cisplatin is a ctive and a relatively tolerable regime for patients with non-Hodgkin lymph oma previously treated with adriamycin and etoposide.