Dexamethasone, Etoposide, Ifosfamide and Cisplatin (DVIP) as Salvage Therapy in Non-Hodgkin's Lymphoma and Hodgkin's Disease.

Abstract

26 patients (16 male, 10 female; median age 53 years, range 18–77) with relapsed Non-Hodgkin's Lymphoma or relapsed Hodgkin's Disease were treated with DVIP combination chemotherapy from July 1999 until February 2006. This consisted of 4 consecutive days of Dexamethsone 20 mg IV twice a day, Etoposide 75mg/m2 IV daily, Ifosfamide 1.2 gm/m2 IV daily with Mesna and Cisplatin 20 mg/m2 IV daily. Cycles were repeated every 3 weeks. 14 (53%) of the patients had an aggressive lymphoma (11 diffuse large B cell lymphoma, 2 anaplastic large T cell lymphoma, 1 immunoblastic lymphoma). 7 (26%) patients had an indolent lymphoma (5 Follicular Lymphoma, 2 splenic lymphoma with villous lymphocytes of which one had a blastic transformation). 5 (19%) patients had Hodgkin's Disease. 19 (73%) patients received DVIP as a second line of therapy, 5 (19%) as third line therapy and one after 5 previous regimes. The median number of cycles given was 3 (range 1–6).There was a total response rate of 54% (14) : CR 35% (9) and PR 19% (5). In 11 (42%) of the remaining patients stable disease was documented and one had disease progression with this therapy. 7 of the 9 in CR underwent successful PBSC mobilization and then received consolidation with high dose chemotherapy (HDCT) and autologous stem cell support. All of these are alive and in CR at a median of 55 months (range 2 – 80 months) post DVIP therapy. One patient in PR who underwent this procedure died 12 months later from disease progression.Overall mean survival (OS) of all 7 patients who achieved CR was 70 months (95%CI = 53-87 months). A significantly lower mean OS of 13.5 months (95%CI = 3.4-23.6) was observed in those who did not achieve CR (p=0.001).Hematological toxicity such as grade II/IV neutropenia was found in 23 (88%) of patients.Conclusion : DVIP is an active regimen in relapsed aggressive and indolent non-Hodgkin's lymphoma and relapsed Hodgkin's disease. It can be used as cytoreductive treatment prior to PBSC collection and HDCT with autologous stem cell support. Further studies in combination with Rituximab in suitable patients are warranted.