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

J. T. Sandlund, C. H. Pui, H. Mahmoud, Y. Zhou, E. Lowe, S. Kaste, L. E. Kun, M. J. Krasin, M. Onciu, F. G. Behm, R. C. Ribeiro, B. I. Razzouk, S. C. Howard, M. L. Metzger, G. A. Hale, R. Rencher, K. Graham, M. M. Hudson

Research output: Contribution to journalArticle

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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.

Original languageEnglish (US)
Pages (from-to)468-471
Number of pages4
JournalAnnals of Oncology
Volume22
Issue number2
DOIs
StatePublished - Feb 2 2011

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Salvage Therapy
Ifosfamide
Etoposide
Methotrexate
Dexamethasone
Lymphoma
Hodgkin Disease
Non-Hodgkin's Lymphoma
Hematopoietic Stem Cell Transplantation
Confidence Intervals
Poisons
Drug Combinations
Neutropenia
Therapeutics

Keywords

  • Childhood
  • Lymphoma
  • Recurrent
  • Refractory

ASJC Scopus subject areas

  • Hematology
  • Oncology

Cite this

Efficacy of high-dose methotrexate, ifosfamide, etoposide and dexamethasone salvage therapy for recurrent or refractory childhood malignant lymphoma. / Sandlund, J. T.; Pui, C. H.; Mahmoud, H.; Zhou, Y.; Lowe, E.; Kaste, S.; Kun, L. E.; Krasin, M. J.; Onciu, M.; Behm, F. G.; Ribeiro, R. C.; Razzouk, B. I.; Howard, S. C.; Metzger, M. L.; Hale, G. A.; Rencher, R.; Graham, K.; Hudson, M. M.

In: Annals of Oncology, Vol. 22, No. 2, 02.02.2011, p. 468-471.

Research output: Contribution to journalArticle

Sandlund, JT, Pui, CH, Mahmoud, H, Zhou, Y, Lowe, E, Kaste, S, Kun, LE, Krasin, MJ, Onciu, M, Behm, FG, Ribeiro, RC, Razzouk, BI, Howard, SC, Metzger, ML, Hale, GA, Rencher, R, Graham, K & Hudson, MM 2011, 'Efficacy of high-dose methotrexate, ifosfamide, etoposide and dexamethasone salvage therapy for recurrent or refractory childhood malignant lymphoma', Annals of Oncology, vol. 22, no. 2, pp. 468-471. https://doi.org/10.1093/annonc/mdq348
Sandlund, J. T. ; Pui, C. H. ; Mahmoud, H. ; Zhou, Y. ; Lowe, E. ; Kaste, S. ; Kun, L. E. ; Krasin, M. J. ; Onciu, M. ; Behm, F. G. ; Ribeiro, R. C. ; Razzouk, B. I. ; Howard, S. C. ; Metzger, M. L. ; Hale, G. A. ; Rencher, R. ; Graham, K. ; Hudson, M. M. / Efficacy of high-dose methotrexate, ifosfamide, etoposide and dexamethasone salvage therapy for recurrent or refractory childhood malignant lymphoma. In: Annals of Oncology. 2011 ; Vol. 22, No. 2. pp. 468-471.
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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.",
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AU - Pui, C. H.

AU - Mahmoud, H.

AU - Zhou, Y.

AU - Lowe, E.

AU - Kaste, S.

AU - Kun, L. E.

AU - Krasin, M. J.

AU - Onciu, M.

AU - Behm, F. G.

AU - Ribeiro, R. C.

AU - Razzouk, B. I.

AU - Howard, S. C.

AU - Metzger, M. L.

AU - Hale, G. A.

AU - Rencher, R.

AU - Graham, K.

AU - Hudson, M. M.

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N2 - 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.

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