Outpatient fractionated ICE protocol in relapsed/refractory lymphomas: Efficacy and safety

• Published in: Journal of oncology pharmacy practice 2022-03, Vol.28 (2), p.287-295
• Main Authors: Dada, Reyad, Abdelghani, Ehab Mosaad, Boubakra, Tarek, Vayani, Jaweed, Yousof, Osama, Heaphy, Emily L Goldman, Nawaz, Azhar
• Format: Article
• Language: English
• Subjects: Ambulatory Care; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Carboplatin; Carboplatin - adverse effects; CD20 antigen; Etoposide; Etoposide - adverse effects; Humans; Ifosfamide; Ifosfamide - adverse effects; Lymphoma; Lymphoma - drug therapy; Neoplasm Recurrence, Local - drug therapy; Neutropenia; Non-Hodgkin's lymphoma; Remission; Retrospective Studies; Rituximab; Thrombocytopenia
• ISSN: 1078-1552; 1477-092X
• DOI: 10.1177/1078155220988062

Methods In this retrospective trial, we analyzed data of patients with relapsed/refractory lymphoma who received outpatient fractionated ICE between 2011-2017 at a tertiary care center. The three weekly ICE protocol consisted of: ifosfamide 1500 mg/m2 infused over 2 h on days 1–3, carboplatin (5 AUC) on day 1, and etoposide 100 mg/m2 on days 1–3. Rituximab 375 mg/m2 was given to patients with CD20 positive B cell Non-Hodgkin lymphoma. Results Total of 89 patients were included in this research project. Majority of patients had Hodgkin lymphoma (64%). Mean number of ICE cycles received was 2.5. Complete remission and partial remission rates for primary refractory (62.9%) and non-primary refractory (36.4%) disease were 10.5% and 26.3% versus 41.9% and 29.0% respectively. Event free survival rate was 14.5 months (95% CI 7.7–28.0) and overall survival rate 88.7 months (95% CI 48.1–NR). Grade 3 hematological toxicities were documented in 19.1% of patients with 10.1% experiencing neutropenia and 9% thrombocytopenia. 5.6% had febrile neutropenia. Conclusions Our study included, to our knowledge, the largest number of patients treated with outpatient fractionated ICE. Results demonstrated that this regimen might be a reasonable replacement for classic ICE regimen in many patients with lymphoma. It has a favorable safety profile. However, patients with primary refractory lymphomas need more effective regimens.