High-dose ifosfamide and vinorelbine as salvage therapy for relapsed or refractory Hodgkin's disease

In an effort to improve results in patients with relapsed or refractory Hod gkin's disease (HD), an intensive regimen combining vinorelbine (25 mg/m(2) i.v. days 1 and 5) and high-doses of ifosfamide (3000 mg/m(2)/d, days 1-4 by continuous infusion) with mesna uroprotection and C-CSF support was desi gned. Forty-seven patients were treated; 14 had failure to initial inductio n therapy and 33 had disease relapsed from an initial response. The respons e rate was 83%, with 21 complete (45%, CR) and 18 partial remissions (38%, PR). Partial response was achieved after a median of two cycles (range 1-3) and CR after a median of six cycles (range 2-10). At the end of ifosfamide and vinorelbine, 10 patients in CR, one in PR, and one with stable disease also received radiotherapy to nodal sites of relapse. Eleven patients who had undergone peripheral blood stem cell (PBSC) harvesting following ifosfa mide-vinorelbine proceeded to receive high-dose chemotherapy (HDCT) and PBS C transplantation. The main toxic effect was grade III-IV neutropenia, docu mented in 65% of cycles with a median duration of 4 days, and nonhaematolog ical toxicity was mild. The combination of high-doses of ifosfamide and vin orelbine was well tolerated and an active regimen in treatment of patients with relapsed and refractory HD. It was not only useful as salvage therapy with or without consolidative radiotherapy but it also was a valuable induc tion regimen before high-dose intensification therapy followed by PBSC It i nfusion in patients eligible for this approach.