Klin Onkol 2001; 14(3): 90-95.
Abstract: Background: Treatment of early relapsing or resistant non-Hodgkin´s lymphoma (NHL) and Hodgkin´s disease (HD) is not satisfactory. High dose chemotherapy followed by autologous peripheral blood stem cell (PBSC) transplantation offers the possibility to improve prognosis. We adopted the strategy of using salvage chemotherapy as debulking as well as PBSC mobilizing treatment. We used the regimens based on ifosfamide and etoposide because these drugs are not frequently used in the front-line treatment. Patients and treatment: Patients with NHL(n=32) received MINE chemotherapy (n=43. mesna. ifosfamide 1330mg/m2 and etoposide 65 mg/m2 by i. v. infusions on days 1-3. mitoxantrone 8 mg/m2 i. v. on day 1). The same schedule, but higher doses were used for PBSC mobilization (n=32. ifosfamide 1700 mg/m2, etoposide 175 mg/m2, mitoxantrone 10 mg/m2). Patients with HD (n=50) received VIM chemotherapy (n= 116. mesna. ifosfamide 1200 mg/m2 by i. v. infusion on days 1-5. etoposide 90 mg/m2 by i.v.infusion on days 1.3. and 5. methotrexate 30 mg/m2 i.v. on days 1 and 5). After both VIM and MINE mobilization chemotherapy was followed by G-CSF at the dose 5-16 µg/kg/day (mainly 10 µg/kg/day), depending on pretreatment of the patients. Results: The responses after VIM and MINE were CR 36% and 4%. PR 20% and 30%, and SD 2% and 4%, respectively. In both groups, patients with relapsing disease responded more better than those with primary progressive disease. Both regimens exhibited excellent mobilizing capacity. We performed 229 aphereses (median 3 leukaphereses per patient) starting on either day 13 (median: VIM), or on day 12 (median: MINE). In the vast majority of patients, the collection started in the time interval: median ± 1 day (n=70, 85%). The median yields were 10. 7x 106 CD34+ cells/kg and 52.9x 104 CFU-GM/kg for VIM, and 12.5x106 CD34+ cells/kg and 51.5x 104 CFU-GM/kg for MINE. We did not collect atleast 2.5x 106 CD34+ cells/kg in only 7 patients (9%), and the harvested amount of CD34+ cells was lower than 1.0x106/kg in only 2 patients (2%). The toxicity of all 191 VIM and MINE chemoterapies was minimal. PBSC collections were not complicated by chemotherapy-induced trombocytopenia. Forty-seven HD patients (94%) and 26 NHL patients (81%) were transplanted (BEAM or BuCy2 regimens). The recovery of hematopoiesis was rapid in both groups of patients. Median time for reaching white blood cell count 1.0x 109/l was 10 days for both HD and NHL patients, and for thrombocytes > 50x 109/l was 12 days for HD and 11 days for NHL patients, respectively. Conclusion: VIM and MINE are well-tolerated regimens providing significant antiIymphoma effect and low toxicity. In combination with G-CSF. they also provide very good PBSC mobilizing capability in a predictable time interval. These regimens are also advantageous because of short-time leukopenia and mild thrombocytopenia which is critical for ensuring uneventful apheresis. Compared with other regimens, VIM and MINE seem to offer multiple advantages .
