Efficacy of high-dose methotrexate, ifosfamide, etoposide and dexamethasone salvage therapy for recurrent or refractory childhood malignant lymphoma — Ann Oncol

Efficacy of high-dose methotrexate, ifosfamide, etoposide and dexamethasone salvage therapy for recurrent or refractory childhood malignant lymphoma
J. T. Sandlund1,2,*, C-H. Pui1,2, H. Mahmoud1,2, Y. Zhou1,3, E. Lowe1, S. Kaste2,4, L. E. Kun1,4, M. J. Krasin1,4, M. Onciu1,5, F. G. Behm1,5, R. C. Ribeiro1,2, B. I. Razzouk1,2, S. C. Howard1,2, M. L. Metzger1,2, G. A. Hale1,2, R. Rencher1, K. Graham1 and M. M. Hudson1,2

Ann Oncol (2011) 22 (2): 468-471.
doi: 10.1093/annonc/mdq348
First published online: July 12, 2010

+ Author Affiliations
1Department of Oncology, St Jude Children’s Research Hospital
2Department of Pediatrics, University of Tennessee, Memphis, College of Medicine
3Department of Biostatistics, St. Jude Children's Research Hospital
4Department of Radiological Sciences, St Jude Children’s Research Hospital
5Department of Pathology, St Jude Children’s Research Hospital, Memphis, TN, USA


*Correspondence to: Dr John T. Sandlund, Department of Oncology, St Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA. Tel: +1 901 595-2427; Fax +1 901 521-9005; E-mail: John.Sandlund@stjude.org.

Received May 5, 2010.
Accepted May 7, 2010.


Abstract
Background: Children with recurrent or refractory malignant lymphoma generally have a poor prognosis. There is a need for new active drug combinations for this high-risk group of patients.

Patients and methods: This study evaluated the activity and toxicity of the methotrexate, ifosfamide, etoposide and dexamethasone (MIED) regimen for childhood refractory/recurrent non-Hodgkin’s lymphoma (NHL) or Hodgkin’s lymphoma (HL). From 1991 through 2006, 62 children with refractory/recurrent NHL (n = 24) or HL (n = 38) received one to six cycles of MIED. Based on MIED response, intensification with hematopoietic stem cell transplantation (HSCT) was considered.

Results: There were 10 complete (CR) and 5 partial responses (PR) among the 24 children with NHL [combined response rate, 63%; 95% confidence interval (CI) 38% to 73%]. There were 13 CR and 18 PR among the 37 assessable children with HL (combined response rate, 84%; 95% CI, 68% to 94%). Although 59% courses were associated with grade IV neutropenia, treatment was well tolerated and without toxic deaths.
Conclusions: MIED is an effective regimen for refractory/recurrent childhood malignant lymphoma, permitting a bridge to intensification therapy with HSCT.

Efficacy of high-dose methotrexate, ifosfamide, etoposide and dexamethasone salvage therapy for recurrent or refractory childhood malignant lymphoma — Ann Oncol