High dose ifosfamide in combination with etoposide and epirubicin followedby autologous stem cell transplantation in the treatment of relapsed/refractory Hodgkin's disease: a report on toxicity and efficacy

Patients with Hodgkin's disease (HD) refractory to first line chemotherapy and those who have rapid or multiple relapses have a very poor prognosis. W ith the increasing use of hybrid chemotherapy these patients will have been exposed to many of the drugs active in HD so it is important to develop sa lvage regimens that are novel and demonstrate activity in this group of pat ients. We report the use of a continuous high dose infusion of ifosfamide a t a dose of 9g/m(2) over 3 days in combination with etoposide and epirubici n followed by autologous stem cell transplant with either BEAM or Melphalan /VP16 conditioning in this difficult group. Forty six patients (28M:18F) wi th a median age of 28 years (range 13-35) were treated. Overall 39 out of 4 6 (85%) patients responded to treatment, with 17 achieving complete remissi on and 11 a good partial remission; 28 proceeded to autologous bone marrow/ stem cell transplantation. In total, 23 patients are alive and in continuou s remission with a follow up of between 12 and 61 months. Median overall su rvival for the whole group is 36 months. Haematological toxicity, particula rly neutropenia (WHO grade IV), was observed in all cases but improved over the 3 courses of treatment in all patients. Non-haematological toxicity wa s not a major problem; no significant cardiac, hepatic, renal, pulmonary or neuro toxicity was observed and there were no deaths on treatment. This re gime shows promise in patients with difficult Hodgkin's disease and warrant s further study.