Haim N, Ben-Shahar M, Faraggi D, Tsuri-Etzioni A, Leviov M, Epelbaum R
Department of Oncology, Rambam Medical Center and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa.
Cancer. 1997 Nov 15;80(10):1989-96. doi: 10.1002/(sici)1097-0142(19971115)80:10<1989::aid-cncr17>3.0.co;2-u.
This study analyzed the long term results of a combination of dexamethasone, etoposide, ifosfamide, and cisplatin (DVIP) used at the study center as standard second-line combination therapy in patients with aggressive non-Hodgkin's lymphoma (NHL) after prior exposure to doxorubicin.
All drugs were given intravenously for 4 consecutive days. The maximum daily doses of etoposide, ifosfamide, and cisplatin were 75 mg/m2, 1200 mg/m2, and 20 mg/m2, respectively. The dexamethasone dose was 20 mg twice daily. Cycles were repeated every 3 weeks.
Fifty-six patients were included in the study. Partial response was noted in 18 patients (32%) and complete response (CR) in 18 patients (32%). Pretreatment factors that predicted CR were CR with prior therapy (CR in 17 of 34 in patients with a recurrence vs. 1 of 21 in patients with primary refractory NHL) and age (CR in 12 of 25 patients age < or = 65 years vs. 6 of 31 patients age > 65 years). Median time to treatment failure (TTF) and median survival were 11.5 months and 30 months, respectively, for patients with a CR and 3.5 months and 8 months, respectively, for all patients. Five patients (9%) remained disease free for > 24 months. By multivariate analysis, age was the only independent prognostic factor for TTF, whereas age, serum lactate dehydrogenase, and number of extranodal sites were independent predictors for survival. Myelosuppression (median granulocyte nadir and median platelet nadir of 350/mm3 and 77,000/mm3, respectively) was the major toxicity. There was one possible drug-related death associated with myelosuppression.
DVIP is a relatively safe salvage combination therapy in patients with aggressive NHL. Response to first-line therapy and age are the most important predictors for prognosis after the administration of DVIP. This regimen is highly active in patients with recurrent NHL, but relatively ineffective in patients with primary refractory NHL.
本研究分析了在研究中心作为标准二线联合疗法使用的地塞米松、依托泊苷、异环磷酰胺和顺铂（DVIP）联合用药方案，用于既往接受过阿霉素治疗的侵袭性非霍奇金淋巴瘤（NHL）患者的长期疗效。
所有药物均静脉注射，连续给药4天。依托泊苷、异环磷酰胺和顺铂的最大日剂量分别为75mg/m²、1200mg/m²和20mg/m²。地塞米松剂量为每日2次，每次20mg。每3周重复1个周期。
56例患者纳入本研究。18例患者（32%）出现部分缓解，18例患者（32%）出现完全缓解（CR）。预测CR的预处理因素为既往治疗后的CR（复发患者34例中的17例CR vs 原发性难治性NHL患者21例中的1例CR）和年龄（年龄≤65岁的25例患者中的12例CR vs 年龄>65岁的31例患者中的6例CR）。CR患者的中位治疗失败时间（TTF）和中位生存期分别为11.5个月和30个月，所有患者分别为3.5个月和8个月。5例患者（9%）无病生存>24个月。多因素分析显示，年龄是TTF的唯一独立预后因素，而年龄、血清乳酸脱氢酶和结外部位数量是生存的独立预测因素。骨髓抑制（中位粒细胞最低点和中位血小板最低点分别为350/mm³和77,000/mm³）是主要毒性。有1例可能与药物相关的死亡与骨髓抑制有关。
DVIP是侵袭性NHL患者相对安全的挽救性联合疗法。一线治疗的反应和年龄是DVIP给药后预后的最重要预测因素。该方案对复发性NHL患者活性高，但对原发性难治性NHL患者相对无效。
