High-dose ifosfamide and mitoxantrone (HDIM) in patients with relapsed or refractory Hodgkin’s lymphoma

Abstract

Relapsed/refractory Hodgkin's lymphoma (HL) is treated with salvage chemotherapy and autologous stem cell transplantation (ASCT). Optimal chemotherapy is unknown. We retrospectively analyzed outcomes of 58 patients treated with 2cycles of high-dose ifosfamide and mitoxantrone (HDIM). HDIM consisted of ifosfamide 5g/m(2)/day and MESNA 5g/m(2)/day in continuous 24-h infusion (days 1 and 2), MESNA 2.5g/m(2) over 12h (day 3), and mitoxantrone 20mg/m(2) (day 1) administered every 2weeks. Stem cells were collected after the first cycle. Responding patients proceeded to ASCT. Toxicity was acceptable. Stem cell mobilization was successful in 96% of patients. Overall response rate was 74% (89% in relapsing and 45% in refractory patients) with 31% complete remissions. After a median follow-up of 54months, 5-year event-free survival was 56% (69% for relapsing and 35% for refractory patients), and 5-year overall survival was 67% (73% for relapsing and 55% for refractory patients). Significant adverse prognostic factors were refractoriness to previous therapy and HDIM failure. No differences in outcomes were noted between patients with early and late relapses or between complete and partial responders. HDIM is a well-tolerated and effective regimen for relapsed and refractory HL with excellent stem cell mobilizing properties. Patients failing HDIM may still benefit from other salvage options.