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 Article

Authors: 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.
Article Title: Ifosfamide, carboplatin, and etoposide: A highly effective cytoreduction and peripheral-blood progenitor-cell mobilization regimen for transplant- eligible patients with non-Hodgkin's lymphoma
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.
Keywords: adolescent; adult; cancer survival; controlled study; aged; disease-free survival; middle aged; major clinical study; clinical trial; cisplatin; cancer combination chemotherapy; neurotoxicity; carboplatin; controlled clinical trial; nephrotoxicity; etoposide; blood toxicity; randomized controlled trial; antineoplastic combined chemotherapy protocols; hematuria; ifosfamide; nonhodgkin lymphoma; leukocytes, mononuclear; lymphoma, non-hodgkin; cardiotoxicity; cell movement; stem cells; hematopoietic stem cell; double blind procedure; granulocyte colony-stimulating factor; hematopoietic stem cell mobilization; humans; prognosis; human; male; female; priority journal; article
Journal Title: Journal of Clinical Oncology
Volume: 17
Issue: 12
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 1999-12-01
Start Page: 3776
End Page: 3785
Language: English
PUBMED: 10577849
PROVIDER: scopus
DOI: 10.1200/JCO.1999.17.12.3776
Notes: Article -- Export Date: 16 August 2016 -- Source: Scopus
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MSK Authors
  1. Joachim Yahalom
    394 Yahalom
  2. Carol Portlock
    178 Portlock
  3. Craig Moskowitz
    368 Moskowitz
  4. Barrett H Childs
    53 Childs
  5. Ariela Noy
    204 Noy
  6. James O'Brien
    16 O'Brien
  7. Diane C Louie
    46 Louie
  8. Richard C Frank
    19 Frank
  9. David B Agus
    27 Agus
  10. Eric E Hedrick
    16 Hedrick
  11. Joseph Bertino
    256 Bertino
  12. Nancy Coady Lyons
    8 Lyons
  13. Joseph G Jurcic
    127 Jurcic
  14. Andrew D Zelenetz
    546 Zelenetz
  15. Stephen D Nimer
    339 Nimer
  16. Daniel A Filippa
    98 Filippa
  17. David J Straus
    205 Straus
  18. Andre Goy
    27 Goy
  19. Sonia L Hunte
    3 Hunte