Proctor S J, Taylor P R, Angus B, Wood K, Lennard A L, Lucraft H, Carey P J, Stark A, Iqbal A, Haynes A, Russel N, Leonard R C, Culligan D, Conn J, Jackson G H
Nottingham University Hospital, UK.
Eur J Haematol Suppl. 2001 Jul;64:28-32.
One hundred and seven patients (61 with diffuse large B-cell non-Hodgkin's lymphomas and 46 with Hodgkin's disease) in relapse or following of primary therapy received ifosfamide 3 g/m2 i.v. daily for 3 days in combination with epirubicin 50 mg/m2 i.v. day 1 and etoposide 200 mg/m2 i.v. days 1-3. Of the 46 patients with Hodgkin's disease (28 male, 18 female, and a median age of 28 years) 85% of patients had a response to treatment, with 17 achieving complete remission and 11 good partial remission. Twenty-eight proceeded to autologous bone marrow or peripheral blood stem cell transplantation. Twenty-three patients remain alive in continuous remission with a follow-up of 12-61 months. The median overall survival time for all patients in this group is 36 months. Haematological toxicity, particularly WHO Grade IV neutropenia, occurred in all patients but improved over the three courses of treatment. There was no major non-haematological toxicity. Further trials of this regimen in this clinical situation are indicated. The patients with non-Hodgkin's lymphomas in this study had diffuse large B-cell lymphomas and had only received first-line treatment. Twenty had primarily refractory disease, 15 had only achieved partial remissions (PR), and 26 had developed relapse following primary treatment. The overall response rate was 43%; it was 60% for those who had achieved initial PR, 58% for those in relapse after an initial CR or very good PR following initial therapy, but only 10% for those with primarily refractory disease. Tolerance to the regimen was similar to that observed in treatment of the patients with Hodgkin's disease and many were able to undergo stem cell collection, following mobilization with this regimen. The 2-year overall survival result was 22% for patients with some response to first-line treatment but 0% for primary refractory patients.
107例复发或接受初始治疗后的患者（61例弥漫性大B细胞非霍奇金淋巴瘤患者和46例霍奇金病患者）接受了异环磷酰胺3 g/m²静脉注射，每日1次，共3天，联合表柔比星50 mg/m²静脉注射第1天以及依托泊苷200 mg/m²静脉注射第1 - 3天。46例霍奇金病患者（28例男性，18例女性，中位年龄28岁）中，85%的患者对治疗有反应，17例达到完全缓解，11例达到良好部分缓解。28例患者进行了自体骨髓或外周血干细胞移植。23例患者持续缓解存活，随访时间为12 - 61个月。该组所有患者的中位总生存时间为36个月。血液学毒性，尤其是世界卫生组织IV级中性粒细胞减少症，在所有患者中均有发生，但在三个疗程的治疗过程中有所改善。未出现严重的非血液学毒性。表明该方案在这种临床情况下需要进一步试验。本研究中的非霍奇金淋巴瘤患者为弥漫性大B细胞淋巴瘤，且仅接受了一线治疗。20例患者为原发性难治性疾病，15例仅达到部分缓解（PR），26例在初始治疗后出现复发。总体缓解率为43%；初始达到PR的患者缓解率为60%，初始治疗后达到CR或非常好的PR后复发的患者缓解率为58%，但原发性难治性疾病患者的缓解率仅为10%。该方案的耐受性与霍奇金病患者治疗中观察到的情况相似，许多患者在使用该方案动员后能够进行干细胞采集。一线治疗有反应的患者2年总生存结果为22%，但原发性难治性患者为0%。
