Researchers from Italy have reported that a regimen consisting of hyperfractionated cyclophosphamide, high-dose cytarabine and methotrexate followed by autologous or allogeneic stem cell transplantation results in long-term survival in 50% of patients with aggressive, refractory or recurrent non-Hodgkin’s lymphoma (NHL). The details of this report appeared in the August 1, 2005, issue of Cancer .

Patients with aggressive NHL who fail doxorubicin-based combination chemotherapy can only be cured by an autologous or allogeneic stem cell transplant. However, in order to benefit from a stem cell transplant patients must respond to re-induction therapy. Thus, it is important to treat patients with an effective regimen. Patients with NHL who have failed primary treatment are usually treated with combination chemotherapy. One of the oldest regimens in use is the combination of dexamethasone, cytarabine and cisplatin (DHAP). More recent regimens include etoposide containing regimens such as ESHAP (etoposide, cisplatin, cytarabine and methylprednisone) and ICE (iphosphamide,carboplatin and etoposide). The addition of Rituxan® (rituximab) to any of these regimens improves the response rate and is an important component of salvage therapy.

The current study evaluated an intensive inpatient regimen of hyperfractionated cyclophosphamide, cytarabine and methotrexate with citrovorin rescue in a poor prognosis group of patients with NHL who had failed anthracycline-based therapy. Neupogen® (filgrastim) was administered after completion of this regimen. All patients in this study were under the age of 60 years and the median age was 44 years. One patient died of treatment related complications. The complete response rate was 64% with 21% achieving a partial response. Sixteen patients who achieved a complete response underwent an autologous or allogeneic stem cell transplant. Overall and progression-free survival was approximately 50% for the entire group of patients with most survivors having received a transplant. Progression-free survival was 67% for the 15 patients entering the trial with progressive or refractory disease.

Comments:  These results are very good for this cohort of patients and represents a very aggressive approach to treatment in this very bad risk group of younger patients with aggressive NHL.

Reference: Todeschini G, Tecchio C, Pasini F, et al. Hyperfractionated cyclophosphamide and high-doses of arabinosylcytosine and methotrexate (HyperCHiDAM Verona 897). An intensive and effective regimen for patients with aggressive, refractory or recurrent non-Hodgkin lymphomas after anthracycline-containing regimens. Cancer. 2005;104:555-560.

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