Dose-Modified Ifosfamide, Epirubicin, and Etoposide is a Safe and Effective Salvage Therapy with High Peripheral Blood Stem Cell Mobilization Capacity for Poorly Mobilized Hodgkin's Lymphoma and Non-Hodgkin's Lymphoma Patients

• Published in: Journal of Clinical and Experimental Hematopathology 2016-06, Vol.56 (1), p.50-54
• Main Authors: Akiko Fukunaga, Mizuki Hyuga, Makoto Iwasaki, Yoshiki Nakae, Wataru Kishimoto, Yoshitomo Maesako, Nobuyoshi Arima
• Format: Article
• Language: Japanese
• ISSN: 1346-4280

A dose modified ifosfamide, epirubicin, and etoposide (IVE) regimen was prospectively assessed for its efficacy in mobilizing peripheral blood stem cells for autologous transplantation. Two patients with Hodgkin's lymphoma and two with non-Hodgkin's lymphoma who were undergoing stem cell therapy were studied. All patients had a history of multiple treatments with insufficient stem cell mobilization. The dose modified IVE regimen consisted of ifosfamide 3 g/m2 intravenously (IV) administered on days 1-2 in combination with epirubicin 50 mg/m2 IV on day 1 and etoposide 200 mg/m2 (100 mg/m2 in two patients with complete remission) IV on days 1-3. The ifosfamide dosage was reduced to two-thirds of the original protocol. A substantial high yield of CD34+ cells was achieved when patients were treated with a dose-modified IVE regimen, compared with that during the previous regimen (two with the ifosfamide, carboplatin, and etoposide [ICE] regimen, one with high-dose cyclophosphamide and one with the original IVE regimen). Two patients who had refractory and residual disease received a 200 mg/m2 dose of etoposide, which resulted in tumor reduction (one patient with complete remission and one with further reduction in tumor size). After the IVE regimen, all four patients had a sufficient yield of CD34+ cells in total, which was available for stem cell transplantation. Hematological and non-hematological toxicities were comparable in all regimens. This singlecenter prospective study demonstrated that the dose-modified IVE regimen can be used as a safe treatment with high mobilizing efficacy in heavily pretreated lymphoma patients.