The role of ifosfamide in the treatment of relapsed and refractory lymphoma

Ifosfamide is an alkylating agent with proven efficacy in the treatment of solid tumours and malignant lymphomas. Because it causes only mild to moder ate myelosuppression, ifosfamide is often used in combination regimens with other agents, Ifosfamide has been mainly used in therapy of lymphoma as a component of salvage regimens, but high-dose ifosfamide is also effective i n the mobilization of peripheral stem cells for treatment of patients with relapsed or refractory lymphoma with regimens containing autologous stem ce ll transplantation. Based on promising data with a new combination regimen containing idarubicin, etoposide and ifosfamide (IIVP-16) in patients with poor-risk non-Hodgkin's lymphoma, we have performed a phase II study using DIZE (dexamethasone 20 mg i.v. days 1-4, idarubicin 8 mg/m(2) i.v. days 1+2 , ifosfamide 1.0 g/m(2) continuous infusion (c.i.) days 1-4, and etoposide 160 mg/m(2) c.i. days 1-4) in patients with relapsed or refractory Hodgkin' s and non-Hodgkin's lymphoma. In 43 evaluable patients, the response rate w as 58%, including 11 complete remissions (CR) and 14 partial remissions (PR ). The mean duration of response was 8 months (1-30). Myelosuppression was generally mild with mean duration of neutropenia < 1000/muL of 2.5 days (ra nge 0-18) and thrombocytopenia < 25 000/muL of 1.5 days (0-17). Thus, DIZE is an effective and safe regimen for pretreated patients with aggressive ly mphoma. These results appear to compare favourably with other salvage regim ens such as IMVP-16 or DHAP. In conclusion, salvage regimens containing ifo sfamide can play an important role in patients who are not eligible fur hig h-dose chemotherapies. Moreover, ifosfamide might also have a role in reduc ing tumour burden and selecting those patients who qualify for HDCT.