Salvage chemotherapy with IAPVP-16 for advanced refractory or relapsed follicular lymphomas

• Published in: Haematologica (Roma) 1999-10, Vol.84 (10), p.911
• Main Authors: Lopez, R, Martino, R, Brunet, S, Sureda, A, Domingo-Albos, A, Sierra, J
• Format: Article
• Language: English
• Subjects: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Antineoplastic Combined Chemotherapy Protocols - toxicity; Carmustine - administration & dosage; Carmustine - toxicity; Cyclophosphamide - administration & dosage; Cyclophosphamide - toxicity; Disease-Free Survival; Etoposide - administration & dosage; Etoposide - toxicity; Female; Humans; Lymphoma, Follicular - drug therapy; Lymphoma, Follicular - mortality; Male; Middle Aged; Recurrence; Salvage Therapy; Survival Rate; Treatment Outcome
• ISSN: 0390-6078; 1592-8721

Servei d'Hematologia Clinica, Hospital de la Santa Creu i Sant Pau, Av. Sant Antoni Maria Claret, 167, 08025 Barcelona, Spain. [e-mail] BACKGROUND AND OBJECTIVE: Patients with follicular lymphoma (FL) who do not respond to first-line chemotherapy or those who relapse after obtaining a remission have a poor outcome with standard treatment. In an effort to obtain a high rate of responses we designed an intensive brief duration salvage chemotherapy regimen. DESIGN AND METHODS: Forty-four consecutive patients with advanced follicular lymphoma were treated. Nine had primary refractory disease, 13 had achieved a partial remission, 16 were in untreated relapse or progression and six were in chemosensitive relapse. The IAPVP-16 regimen consists in ifosfamide 5 g/m(2) iv on day 1, etoposide 100 mg/m(2) iv on days 1-3, Ara-C 1.2 g/m(2)/12 hours iv on days 1-2 and methylprednisolone, 80 mg/m(2) iv on days 1-5. Granulocyte colony-stimulating factor was used from day 6 in 68 of 114 courses. RESULTS: Eighteen patients (41%) achieved a complete remission and 17 (39%) a partial remission, for an overall response rate of 80%. There were no treatment-related deaths. All treatment courses were followed by severe neutropenia, and 66% also by severe thrombocytopenia, but there were no serious hemorrhagic events. Neutropenic fever occurred in 56% of the courses with only four severe infections. Non-hematologic toxicity was modest. Twenty-eight patients proceeded to a stem cell transplantation. After a median follow-up of 25 months (range 4-95), the median progression-free survival and overall survival are 32 and 58 months, respectively. The median PFS was 33 months for responders and 11 months for non-responders (p=0.05), while the median OS has not been reached in responders and is 23 months in non-responders (p=0.0005). INTERPRETATION AND CONCLUSIONS:. The IAPVP-16 regimen is an effective and well tolerated treatment for advanced FL, allowing most eligible patients to proceed with significant tumor reduction to high-dose therapy and SCT.