HIGH-DOSE CYTARABINE AND MITOXANTRONE AS SALVAGE THERAPY FOR REFRACTORY NON-HODGKINS-LYMPHOMA

High-dose cytarabine alone or in combination with mitoxantrone has bee n shown to be active against refractory non-Hodgkin's lymphoma in ther apeutic trials. We administered these two drugs to 16 patients with ad vanced and refractory non-Hodgkin's lymphoma. Cytarabine was administe red at 3 g/m(2) as a 2-h intravenous infusion every 12 h on days 1-4 ( 8 doses) and mitoxantrone at 6 mg/m(2)/day as a l-h intravenous infusi on on days 1-5. The clinical efficacy and toxicity were assessed accor ding to the WHO criteria. Five patients (31%, 95% CI: 8-54%) attained complete remission and two had partial remission. In three of the five complete remission patients, the remission lasted for >4 months. The remaining two patients had complete remission for only 1.3 months. Mye losuppression with subsequent infection was the major toxicity of this regimen. Severe leukopenia (WBC <1000/mu l) lasted for an average of 20 days and thrombocytopenia (<25 000/mu l) 18 days, Five patients (31 %) died of treatment-related complications: neutropenia-associated sep sis in three, pneumonia in one and electrolyte imbalance in one. Nonmy eloid toxicities included alopecia in 100% (19% Gr.2, 75% Gr.3), stoma titis in 88% (13% Gr.2, 31% Gr.3), hepatotoxicity in 38% (6% Gr.2, 6% Gr.3), dermatitis in 31% (19% Gr.2), CNS toxicity in 25% (6% Gr.2, 6% Gr.3), infection in 38% (13% Gr.3, 19% Gr.4) and chemical conjunctivit is in 6% (Gr.2). We conclude that a proportion of refractory non-Hodgk in's lymphoma cases will respond to high-dose cytarabine + mitoxantron e, but that the treatment seems too toxic to be acceptable as salvage therapy for refractory non-Hodgkin's lymphoma.