Ifosfamide, carboplatin, and etoposide: A highly effective cytoreduction and peripheral-blood progenitor-cell mobilization regimen for transplant-eligible patients with non-Hodgkin's lymphoma
Ifosfamide, carboplatin, and etoposide: A highly effective cytoreduction and peripheral-blood progenitor-cell mobilization regimen for transplant-eligible patients with non-Hodgkin's lymphoma
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DOI：
10.1200/jco.1999.17.12.3776
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发表时间：
1999-12-01
影响因子：
45.3
通讯作者：
Zelenetz, AD
中科院分区：
文献类型：
--
作者：
Moskowitz, CH;Bertino, JR;Zelenetz, AD
目的：评价一种化疗方案，包括异环磷酰胺输注联合卡铂，依托泊苷（ICE）联合粒细胞集落刺激因子（G-CSF），用于原发性难治性或复发性非霍奇金淋巴瘤（NHL）患者的细胞减少和干细胞动员。患者和方法：1993年10月至1997年12月，在纪念斯隆-凯特琳癌症中心，163例符合移植条件的复发性或原发性难治性NHL患者接受ICE化疗。计划以2周为间隔进行3个周期的ICE化疗。在第3个周期后收集外周血祖细胞，所有对ICE化疗达到部分缓解（PR）或完全缓解（CR）的患者都有资格进行移植。无事件和总生存率，ICE相关的毒性，并与ICE和G-CSF治疗后收集的CD 34（+）细胞的数量进行了evaluated.Results：所有163例患者的反应进行评估，并没有治疗相关的死亡率。主要反应（CR/PR）在108例患者（66.3%）中是明显的; 89%的反应患者成功进行了移植。接受移植并达到ICE CR的患者的总生存率上级达到PR的患者（65% vs 30%; P = 0.003）。采集的CD 34（+）细胞/kg的中位数为8.4 x 10（6）。ICE的剂量限制性毒性导致血液学湿润，29.4%的患者发生3/4级血小板减少症。有最小的非血液学副作用。结论：ICE化疗，异环磷酰胺作为24小时输注给药，以减少中枢神经系统的副作用，并取代卡铂顺铂，以尽量减少肾毒性，是一个非常有效的细胞减少和动员方案，在NHL患者。此外，对ICE的临床反应质量可预测移植后结局。J Clin Oncol 17：3776-3785，（C）1999，美国临床肿瘤学会。
Purpose: To evaluate a chemotherapy regimen that consisted of ifosfamide administered as an infusion with bolus carboplatin, and etoposide (ICE) supported by granuloctye colony-stimulating factor (G-CSF) for cytoreduction and stem-cell mobilization in transplant-eligible patients with primary refractory or relapsed non-Hodgkin's lymphoma (NHL).Patients and Methods: One hundred sixty-three transplant-eligible patients with relapsed or primary refractory NHL were treated from October 1993 to December 1997 with ICE chemotherapy at Memorial Sloan-Kettering Cancer Center. Administration of three cycles of ICE chemotherapy was planned at 2-week intervals. Peripheral-blood progenitor cells were collected after cycle 3, and all patients who achieved a partial response (PR) or complete response (CR) to ICE chemotherapy were eligible to proceed to transplantation. Event-free and overall survival, ICE-related toxicity, and the number of CD34(+) cells collected after treatment with ICE and G-CSF were evaluated.Results: All 163 patients were assessable for response, and there was no treatment-related mortality. A major response (CR/PR) was evident in 108 patients (66.3%); 89% of the responding patients underwent successful transplantation. Patient who underwent transplantation and achieved a CR to ICE had a superior overall survival to that of patients who achieved a PR (65% v 30%; P =.003). The median number of CD34(+) cells/kg collected was 8.4 x 10(6). The dose-limiting toxicity of ICE wets hematologic, with 29.4% of patients developing grade 3/4 thrombocytopenia. There were minimal nonhematologic side effects.Conclusion: ICE chemotherapy, with ifosfamide administered as a 24-hour infusion to decrease CNS side effects, and the substitution of carboplatin for cisplatin to minimize nephrotoxicity, is a very effective cytoreduction and mobilization regimen in patients with NHL. Furthermore, the quality of the clinical response to ICE predicts for posttransplant outcome. J Clin Oncol 17:3776-3785, (C) 1999 by American Society of Clinical Oncology.