Ifosfamide, carboplatin, and etoposide: A highly effective cytoreduction and peripheral-blood progenitor-cell mobilization regimen for transplant- eligible patients with non-Hodgkin's lymphoma

Craig Moskowitz, Joseph R. Bertino, Jill R. Glassman, Eric E. Hedrick, Sonia Hunte, Nancy Coady-Lyons, David B. Agus, Andre Goy, Joseph Jurcic, Ariela Noy, James O'Brien, Carol S. Portlock, David S. Straus, Barrett Childs, Richard Frank, Joachim Yahalom, Daniel Filippa, Diane Louie, Stephen D Nimer, Andrew D. Zelenetz

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Abstract

Purpose: To evaluate a chemotherapy regimen that consisted of ifosfamide administered as an infusion with bolus carboplatin, and etoposide (ICE) supported by granuloctye colony-stimulating factor (G-CSF) for cytoreduction and stem-cell mobilization in transplant-eligible patients with primary refractory or relapsed non-Hodgkin's lymphoma (NHL). Patients and Methods: One hundred sixty-three transplant-eligible patients with relapsed or primary refractory NHL were treated from October 1993 to December 1997 with ICE chemotherapy at Memorial Sloan-Kettering Cancer Center. Administration of three cycles of ICE chemotherapy was planned at 2-week intervals. Peripheral- blood progenitor cells were collected after cycle 3, and all patients who achieved a partial response (PR) or complete response (CR) to ICE chemotherapy were eligible to proceed to transplantation. Event-free and overall survival, ICE-related toxicity, and the number of CD34+ cells collected after treatment with ICE and G-CSF were evaluated. Results: All 163 patients were assessable for response, and there was no treatment-related mortality. A major response (CR/PR) was evident in 108 patients (66.3%); 89% of the responding patients underwent successful transplantation. Patient who underwent transplantation and achieved a CR to ICE had a superior overall survival to that of patients who achieved a PR (65% v30%; P = .003). The median number of CD34+ cells/kg collected was 8.4 :< 106. The dose-limiting toxicity of ICE was hematologic, with 29.4% of patients developing grade 3/4 thrombocytopenia. There were minimal nonhematologic side effects. Conclusion: ICE chemotherapy, with ifosfamide administered as a 24-hour infusion to decrease CNS side effects, and the substitution of carboplatin for cisplatin to minimize nephrotoxicity, is a very effective cytoreduction and mobilization regimen in patients with NHL. Furthermore, the quality of the clinical response to ICE predicts for posttransplant outcome.

Original languageEnglish
Pages (from-to)3776-3785
Number of pages10
JournalJournal of Clinical Oncology
Volume17
Issue number12
StatePublished - Dec 1 1999
Externally publishedYes

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ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Moskowitz, C., Bertino, J. R., Glassman, J. R., Hedrick, E. E., Hunte, S., Coady-Lyons, N., Agus, D. B., Goy, A., Jurcic, J., Noy, A., O'Brien, J., Portlock, C. S., Straus, D. S., Childs, B., Frank, R., Yahalom, J., Filippa, D., Louie, D., Nimer, S. D., & Zelenetz, A. D. (1999). Ifosfamide, carboplatin, and etoposide: A highly effective cytoreduction and peripheral-blood progenitor-cell mobilization regimen for transplant- eligible patients with non-Hodgkin's lymphoma. Journal of Clinical Oncology, 17(12), 3776-3785.