Risk-adapted therapy for relapsed and refractory lymphoma using ICE chemotherapy.

At Memorial Sloan Kettering Cancer Center, New York, we have treated over 400 patients with ICE chemotherapy after failure of upfront anthracycline-based therapy with a response rate of 72% in aggressive non-Hodgkin's lymphoma (NHL) and 84% in Hodgkin's disease. Utilizing this database, we have identified pretreatment prognostic markers capable of predicting the quality of response (complete response vs partial response vs failure) to second-line cytoreductive ICE chemotherapy and consequently autologous stem cell transplantation. We have shown that in aggressive NHL, patients achieving a complete response have superior survival when compared to those achieving only a partial response. By identifying a priori those patients destined to have only a partial response to ICE, we will be able to target a group of chemosensitive patients who are most likely to benefit from improved treatment. Novel treatment strategies designed to increase their complete response rate would be anticipated to improve their long-term survival.