Dexamethasone, ifosfamide, cisolatin and etoposide with involved field radiotherapy in relapsed or refractory non hodgkin s lymphoma

ABSTRACT

To evaluate the tolerance and efficacy of dexamethasone, ifosfamide, cisplatin, and etoposide [DICE] combination chemotherapy regimen, as salvage the rapy for relapsed or refractory patients with intermediate and high-grade Non-Hodgkin's lymphoma [NHL]. It is a prospective trial that included forty-patients with refractory or relapsed NHL. All patients had a histological confirmation of intermediate or high-grade NHL and received DICE regimen. Toxicities were recorded according to the WHO scoring. Radiotherapy was given as involved-field [36 Gy in 20 fractions, 180 cGy per fraction] and began three weeks after the last cycle of chemotherapy. Patients were evaluated for response rate [RR], time to treatment failure [TTF], overall survival [OS] and prognostic factors that affect these variables. The overall response rate to treatment was 26.7%, and 35.5% achieved partial response. By adding involved field radiotherapy to chemotherapy, CR increased to 37.8%, and the overall response rate was 60%. Significant factors that affect response rate were stage at relapse, p=0.0001, IPI p=0.002], and disease status [p=0.03]. Time to treatment failure was significantly affected by IPI [p=0.04]. The median time to treatment failure was 8 months while the median OS was 12.5 months. Grade 3 and 4 neutropenia were observed in 31%, nausea and vomiting in 15.6%. Most of the chemotherapy toxicities were mild or moderate and manageable. DICE regimen is an effective salvage chemotherapy for patients with intermediate and high grade NHL. Most of the chemotherapy toxicities were mild or moderate and manageable. Neutropenia was the main dose-limiting toxicity