Original Article

International Journal of Hematology

, Volume 94, Issue 1, pp 90-96

First online:

An effective salvage treatment using ifosfamide, etoposide, cytarabine, dexamethasone, and rituximab (R-IVAD) for patients with relapsed or refractory aggressive B-cell lymphoma

  • Katsuhiro MiuraAffiliated withDivision of Medicine, Department of Hematology and Rheumatology, Nihon University School of Medicine Email author 
  • , Kazuhiro TakeiAffiliated withDivision of Medicine, Department of Hematology and Rheumatology, Nihon University School of Medicine
  • , Sumiko KobayashiAffiliated withDivision of Medicine, Department of Hematology and Rheumatology, Nihon University School of Medicine
  • , Satomi KisoAffiliated withDivision of Medicine, Department of Hematology and Rheumatology, Nihon University School of Medicine
  • , Yukio HirabayashiAffiliated withDivision of Medicine, Department of Hematology and Rheumatology, Nihon University School of Medicine
  • , Atsuko HojoAffiliated withDivision of Medicine, Department of Hematology and Rheumatology, Nihon University School of Medicine
  • , Hitomi KodairaAffiliated withDivision of Medicine, Department of Hematology and Rheumatology, Nihon University School of Medicine
  • , Mai YagiAffiliated withDivision of Medicine, Department of Hematology and Rheumatology, Nihon University School of Medicine
  • , Daisuke KuritaAffiliated withDivision of Medicine, Department of Hematology and Rheumatology, Nihon University School of Medicine
    • , Yujin KobayashiAffiliated withDivision of Medicine, Department of Hematology and Rheumatology, Nihon University School of Medicine
    • , Toshitake TanakaAffiliated withDivision of Medicine, Department of Hematology and Rheumatology, Nihon University School of Medicine
    • , Noriyoshi IriyamaAffiliated withDivision of Medicine, Department of Hematology and Rheumatology, Nihon University School of Medicine
    • , Yoshihiro HattaAffiliated withDivision of Medicine, Department of Hematology and Rheumatology, Nihon University School of Medicine
    • , Yoshimasa KuraAffiliated withDivision of Medicine, Department of Hematology and Rheumatology, Nihon University School of Medicine
    • , Tetsuo YamazakiAffiliated withDivision of Medicine, Department of Hematology and Rheumatology, Nihon University School of Medicine
    • , Umihiko SawadaAffiliated withDivision of Medicine, Department of Hematology and Rheumatology, Nihon University School of Medicine
    • , Jin TakeuchiAffiliated withDivision of Medicine, Department of Hematology and Rheumatology, Nihon University School of Medicine

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Abstract

We evaluated the efficacy and toxicity of a new salvage regimen, consisting of rituximab (375 mg/m2, day 1), ifosfamide (1500 mg/m2 on days 3–7), etoposide (150 mg/m2, days 3–5), cytarabine (100 mg/m2, days 3–5) and dexamethasone (40 mg/body, days 3–5) (R-IVAD) for relapsed or refractory aggressive B-cell lymphoma. In this study, a total of 32 patients with a median age of 64 years (range 38–79) who received an average of 2.6 cycles of R-IVAD from 2001 to 2009 in our institution were retrospectively analyzed. R-IVAD was given every 3 weeks up to a total of three courses with support by granulocyte colony stimulating factor. The overall response rate was 72%, with 56% complete response. On a median follow-up of 16 months (range 2–99), estimated 2-year overall survival (OS) and event-free survival were 55% and 36%, respectively. Of these patients, 10 successfully proceeded to consolidating high-dose chemotherapy followed by autologous stem cell transplantation, accounting for 90% of the 2-year OS. No treatment-related mortality was observed during the investigation. We, therefore, conclude that R-IVAD regimen is a safe and efficacious alternative for patients with relapsed or refractory aggressive B-cell lymphoma.

Keywords

Aggressive B-cell lymphoma Refractory Relapse Rituximab Salvage