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

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 two cycles of high-dose ifosfamide and mitoxantrone (HDIM). HDIM consisted of ifosfamide 5 g/m2/day and MESNA 5 g/m2/day in continuous 24-hour infusion (days 1, 2), MESNA 2.5 g/m2 over 12 hours (day 3), and mitoxantrone 20 mg/m2 (day 1) administered every two weeks. 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 54 months, 5-year event-free survival was 56% (69% for relapsing, 35% for refractory patients), and 5-year overall survival was 67% (73% for relapsing, 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 nor 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.

Hodgkin’s lymphoma ; Antineoplastic combined chemotherapy protocols ; Ifosfamide ; Mitoxantrone ; Autologous stem cell transplatation

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