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Lymphoma, Refractory NHL

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Should we treat or not???
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ICE
EPOCH
ESHAP

ICE Chemotherapy for Lymphoma

IFOSFAMIDE 5 g/m2 mixed with 5 g/m2 MESNA C.I. over 24 hours on DAY 2
CARBOPLATIN AUC=5 (capped at 800 mg) IVB on DAY 2
ETOPOSIDE 100 mg/m2 IVB on DAY1,2,3
GCSF 5 ug/kg DAYS 5-12 for the first 2 cycles
GCSF 10 ug/kg beginning on DAY 5 of 3rd cycle and continuing through leukapheresis

Cycles to be administered every 14 days for a total of 3 cycles

REF: Blood 96:2399, 2000
High-dose chemotherapy and autologous stem cell transplant for patients with primary refractory aggressive non-hodgkin lymphoma: an intention to treat analysis. (N=85)
All patients CR=14 PR=29 ORR=50.6%

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EPOCH Regimen (followed by SCT):

Etoposide 200 mg/m2 IV 96 hr CI
Doxorubicin 40 mg/m2 IV 96 hr CI
Vincristine 1.6 mg/m2 IV 96 hr CI
Cyclophosphamide 750 mg/m2 IV on DAY-5
Prednisone 60 mg/m2 QD X 5 days (DAY-1 to DAY-5)

Dose reduce cyclophosphamide by 25% if ANC<500/ul
Delay therapy if DAY-1 ANC<1000/ul
REF: JCO 18:3135, 2000
5-year survival (EPOCH without SCT): 37%
Overall response (all patients): 74% (24% CR)

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ESHAP

Etoposide 40 mg/m2 IV days 1-4
Methylprednisolone 500 mg IV days 1-4
Cytarabine 2000 mg/m2 IV day 5
Cisplatin 25 mg/m2 CIV days 1-4


Ref: Velasquez W, et al: Proc ASCO 8:256 (abstract) (1986).
Cabanillas F: Ann Oncol 2 (suppl 1):31-32, 1991.
Cabanillas F, Rodiquez A, Swan F, et al: Proc Am Soc Clin Oncol 10:273, 1991.

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