Salvage chemotherapy with IAPVP-16 for advanced refractory or relapsed follicular lymphomas

Background and Objectives. Patients with follicular lymphoma (FL) who do no t respond to first-line chemotherapy or those who relapse after obtaining a remission have a poor outcome with standard treatment. In an effort to obt ain a high rate of responses we designed an intensive brief duration salvag e chemotherapy regimen. Design and Methods. Forty-four consecutive patients with advanced follicula r lymphoma were treated. Nine had primacy refractory disease, 13 had achiev ed a partial remission, 16 were in untreated relapse or progression and six were in chemosensitive relapse. The IAPVP-16 regimen consists in ifosfamid e 5 g/m(2) iv on day 1, etoposide 100 mg/m(2) iv on days 1-3, Ara-C 1.2 g/m (2)/12 hours iv on days 1-2 and methylprednisolone, 80 mg/m(2) iv on days 1 -5. Granulocyte colony-stimulating factor was used from day 6 in 68 of 114 courses. Results. Eighteen patients (41%) achieved a complete remission and 17 (39%) a partial remission, for an overall response rate of 80%. There were no tr eatment-related deaths. All treatment courses were followed by severe neutr openia, and 66% also by severe thrombocytopenia, but there were no serious hemorrhagic events. Neutropenic fever occurred in 56% of the courses with o nly four severe infections. Non-hematologic toxicity was modest. Twenty-eig ht patients proceeded to a stem cell transplantation. After a median follow -up of 25 months (range 4-95), the median progression-free survival and ove rall survival are 32 and 58 months, respectively. The median PFS was 33 mon ths for responders and 11 months for non-responders (p=0.05), while the med ian OS has not been reached in responders and is 23 months in non-responder s (p=0.0005). Interpretation and Conclusions. The IAPVP-16 regimen is an effective and we ll tolerated treatment for advanced FL, allowing most eligible patients to proceed with significant tumor reduction to high-dose therapy and SCT. (C)1 999, Ferrata Storti Foundation.