Evaluation of cytosine arabinoside, carboplatin and etoposide chemotherapy in the treatment of relapsing and refractory non-Hodgkin's lymphoma.

Twenty-eight patients (14 with relapsing and 14 with refractory non-Hodgkin's lymphoma; NHL) were treated with a combination of CACE chemotherapy (cytosine arabinoside, carboplatin, and etoposide) and recombinant granulocyte colony-stimulating factor (G-CSF) to investigate the efficacy and adverse effects of this regimen. Twenty-eight NHL patients (16 men and 12 women, median age 52 years) received intravenous infusions of cytosine arabinoside (100 mg/m2) on days 1-7, carboplatin (250 mg/m2) on day 1, and etoposide (70 mg/m2) on days 1-3, as well as the subcutaneous administration of G-CSF (2 micrograms/kg) beginning on day 9. Eleven of 28 (39.3%) patients achieved complete remission (CR) and 10 patients (35.7%) partial remission (PR). Therefore, a total response rate of 75% was achieved. Nine patients with relapsing disease and 2 with refractory NHL achieved CR. Of the 28 patients 51.5% were alive at 3 years, while the 3-year survival rate for those who achieved CR was 87.5%. The 50% disease-free survival duration was 20.8 months. Adverse effects included leukopenia (2 x 10(9)/l) in 4 patients (14.2%) and thrombocytopenia (50 x 10(9)/l) in 18 patients (64.3%). Although the efficacy of the CACE regimen was demonstrated for treatment of relapsing NHL, the efficacy of CACE was not satisfactory for the treatment of refractory NHL. Further study is required to determine the value of the CACE regimen as therapy for the refractory NHL.