A pilot study of CODOX-M/IVAC in primary refractory or relapsed high-grade non-Hodgkin's lymphoma. A Scotland and Newcastle Lymphoma Group Study

• Published in: Haematologica (Roma) Vol. 88; no. 12; pp. 1366 - 1371
• Main Authors: Davidson, KL, Devaney, MB, Tighe, JE, Rogers, SY, Dunlop, DJ, Mackie, MJ, Thomas, RV, Johnson, PR, Scotland and Newcastle Lymphoma Group Study
• Format: Journal Article
• Language: English
• Published: Pavia Haematologica 01-12-2003
• Subjects: Adult; Antineoplastic agents; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Chemotherapy; Combined Modality Therapy; Cyclophosphamide - administration & dosage; Cyclophosphamide - adverse effects; Cytarabine - administration & dosage; Cytarabine - adverse effects; Disease Progression; Doxorubicin - administration & dosage; Doxorubicin - adverse effects; Drug Administration Schedule; Etoposide - administration & dosage; Etoposide - adverse effects; Female; Granulocyte Colony-Stimulating Factor - therapeutic use; Hematopoietic Stem Cell Mobilization; Humans; Ifosfamide - administration & dosage; Ifosfamide - adverse effects; Injections, Spinal; Leucovorin - administration & dosage; Lymphoma, Non-Hodgkin - drug therapy; Lymphoma, Non-Hodgkin - mortality; Lymphoma, Non-Hodgkin - therapy; Male; Medical sciences; Mesna - administration & dosage; Methotrexate - administration & dosage; Methotrexate - adverse effects; Middle Aged; Peripheral Blood Stem Cell Transplantation; Pharmacology. Drug treatments; Pilot Projects; Prognosis; Recombinant Proteins - therapeutic use; Salvage Therapy; Sepsis - mortality; Treatment Outcome; Vincristine - administration & dosage; Vincristine - adverse effects; Antineoplastic agent; Human; Relapse; relapse/refractory patients salvage therapy; Malignant hemopathy; Refractory; Chemotherapy; Treatment; Lymphoproliferative syndrome; Primary; Malignant lymphoma; Therapeutic protocol; high grade NHL; High malignancy; CODOX-M/IVAC regimen
• ISSN: 0390-6078; 1592-8721

Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK.
BACKGROUND AND OBJECTIVES: The prognosis in patients with primary refractory or relapsed high grade non-Hodgkin's lymphoma (NHL) is very poor--the 5-year survival being generally reported at 10%. DESIGN AND METHODS: Multiple salvage regimens have been investigated and, while response rates of 50-80% have been noted in selected patients, the long-term prognosis remains poor. Following the encouraging results in high risk Burkitt's and Burkitt-like lymphoma using the CODOX-M and IVAC protocols, we performed a pilot study using a similar regimen in patients with primary refractory or relapsed high grade NHL. RESULTS: The regimens were modified by a reduction in the intensity of intrathecal therapy. It was planned to mobilize peripheral blood stem cells following the IVAC cycle for use in subsequent autologous peripheral blood stem cell transplantation in chemosensitive patients. The initial plan was to recruit 50 patients, but the study was closed after 8 due to excessive toxicity. INTERPRETATION AND CONCLUSIONS: We conclude that the CODOX-M/IVAC regimen is too toxic for this group of patients and does not result in better response rates than those to currently available salvage regimens.