Current role and future perspectives for ifosfamide in the treatment of malignant non-Hodgkin’s lymphoma—resultsfrom an expert meeting

Abstract

In this supplemental issue of Annals of Oncology, leading experts from Australia, Europe and the USA present results from their trials using ifosfamide-containing chemotherapy regimens for the treatment of malignant non-Hodgkin’s lymphoma (NHL) and Hodgkin’s disease (HD). The relative merits of the established regimens, achievable treatment results and future perspectives for ifosfamide regimens were discussed during a workshop, held in October 2002 at Cap Ferrat, France. The expert faculty discussed practical issues related to the use of ifosfamide and mesna including suggestions for inpatient and outpatient ifosfamide regimens in combination with rituximab and guidelines for the management of possible side-effects. The practical guidelines for outpatient ifosfamide-based regimens, by fractionating the administration of ifosfamide, infusomates or oral mesna, were discussed as well. Many patients with aggressive NHL can be cured with anthracycline-containing chemotherapy regimens. The benefit of adding rituximab to cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) chemotherapy for non-pretreated elderly patients with aggressive NHL was demonstrated in a recently published randomized trial performed by Groupe d’Etude des Lymphomes de l’Adulte (GELA) [1]. Despite this, more than half of the patients are primarily refractory or relapse and require salvage therapy. A certain subset of patients with chemosensitive disease can be cured with high-dose therapy and stem cell transplantation. Before high-dose therapy, patients usually receive combination chemotherapy regimens to establish tumor chemosensitivity and to reduce tumor bulk. It is critical that a cytoreductive regimen has a high response rate with minimal organ-related toxicities, while at the same time providing adequate collection of peripheral blood stem cells (PBSC).