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 H. 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

Research output: Contribution to journalArticle

255 Scopus citations

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

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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    Moskowitz, C. H., 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. https://doi.org/10.1200/JCO.1999.17.12.3776