Salvage Chemotherapy with Dexamethasone, Etoposide, Ifosfamide and Cisplatin (DVIP) for Relapsing and Refractory Non-Hodgkin's Lymphoma

Background: There is currently no standard salvage chemotherapy for the 40-50% of patients with non-Hodgkin's lymphoma who fail first-line treatment. Objectives: To review the experience of a major tertiary medical center with DVIP (dexamethasone, etoposide, ifosfamide and cisplatin) salvage therapy for primary refractory/relapsing NHL. Methods: We reviewed the records of all patients with NHL who received DVIP salvage therapy during the period 1993 to 2005. Results: We identified 37 adult patients (mean age 56.3 years): 29 with aggressive lymphoma and 8 with indolent lymphoma. Mean event-free survival was 13.5 months (range 0-82 months), mean time between diagnosis and DVIP treatment 18.5 months (range 2-101), and mean number of DVIP cycles 1.9. Four patients (11%) achieved a complete response and 9 (24%) a partial response (overall response 35%). Consolidation with stem cell transplantation was used in 14 patients with aggressive lymphoma and 4 with indolent lymphoma; 14 patients, all with aggressive lymphoma, responded (12 complete, 2 partial). Of the 10 patients who underwent SCT despite no response to salvage DVIP, 6 achieved a complete response. Five year overall survival since the diagnosis for the whole sample was 39.4 +/- 8.7%, and 5 year post-DVIP overall survival 37.6 +/- 8.0%. On multivariate analysis, SCT was the strongest predictor of survival (relative risk 0.73, P < 0.0001) followed by a high score on the International Prognostic Index (RR 3.71, P = 0.032). Conclusions: DVIP salvage therapy for NHL was associated with a low response rate of 35% but a 5 year post-DVIP survival rate of 37.6%. Patients who are refractory to salvage treatment with DVIP might still be salvaged with SCT. IMAJ 2009;11:16-22