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High-dose ifosfamide and mitoxantrone (HDIM) in patients with relapsed or refractory Hodgkin’s lymphoma

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Abstract

Relapsed/refractory Hodgkin’s lymphoma (HL) is treated with salvage chemotherapy and autologous stem cell transplantation (ASCT). Optimal chemotherapy is unknown. We retrospectively analyzed outcomes of 58 patients treated with 2 cycles of high-dose ifosfamide and mitoxantrone (HDIM). HDIM consisted of ifosfamide 5 g/m2/day and MESNA 5 g/m2/day in continuous 24-h infusion (days 1 and 2), MESNA 2.5 g/m2 over 12 h (day 3), and mitoxantrone 20 mg/m2 (day 1) administered every 2 weeks. Stem cells were collected after the first cycle. Responding patients proceeded to ASCT. Toxicity was acceptable. Stem cell mobilization was successful in 96 % of patients. Overall response rate was 74 % (89 % in relapsing and 45 % in refractory patients) with 31 % complete remissions. After a median follow-up of 54 months, 5-year event-free survival was 56 % (69 % for relapsing and 35 % for refractory patients), and 5-year overall survival was 67 % (73 % for relapsing and 55 % for refractory patients). Significant adverse prognostic factors were refractoriness to previous therapy and HDIM failure. No differences in outcomes were noted between patients with early and late relapses or between complete and partial responders. HDIM is a well-tolerated and effective regimen for relapsed and refractory HL with excellent stem cell mobilizing properties. Patients failing HDIM may still benefit from other salvage options.

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Acknowledgments

Presented in part at the 8th International Symposium on Hodgkin’s Lymphoma, Cologne, Germany, 2010.

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Authors and Affiliations

  1. Division of Hematology, Department of Internal Medicine, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia

    Igor Aurer, Damir Nemet, Sandra Bašić-Kinda, Ivo Radman, Dubravka Sertić & Boris Labar

  2. Medical School, University of Zagreb, Zagreb, Croatia

    Igor Aurer, Damir Nemet, Zdravko Mitrović, Dino Dujmović, Fedor Šantek & Boris Labar

  3. Department of Oncology, University Hospital Centre Zagreb, Zagreb, Croatia

    Fedor Šantek

  4. Department of Radiology, University Hospital Centre Zagreb, Zagreb, Croatia

    Marko Kralik

  5. Department of Pathology and Cytology, University Hospital Centre Zagreb, Zagreb, Croatia

    Snježana Dotlić

  6. Department of Transfusion Medicine, University Hospital Centre Zagreb, Zagreb, Croatia

    Sanja Mazić

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  1. Igor Aurer
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  2. Damir Nemet
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Correspondence to Igor Aurer.

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Funding

Supported in part by the Croatian Ministry of Science and Education (grant number 108-1081872-1908).

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The authors declare that they have no conflicts of interest.

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Aurer, I., Nemet, D., Mitrović, Z. et al. High-dose ifosfamide and mitoxantrone (HDIM) in patients with relapsed or refractory Hodgkin’s lymphoma. Ann Hematol 95, 1129–1136 (2016). https://doi.org/10.1007/s00277-016-2676-0

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  • DOI: https://doi.org/10.1007/s00277-016-2676-0

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