Results of second-line chemotherapy regimens against lymphoma have usually been poor. In this study, we used a combination of ifosfamide, methotrexate, and VP-16 to treat 52 patients with lymphoma who had either relapsed or who had failed to attain a complete remission on front-line treatment. Thirty-two patients (62%) responded (CR 37%, PR 25%) and 10 (19%) had a minor response. The median relapse-free interval of the responding patients was 12 mo, and the median survival of the whole group was 15 mo. Of the 18 patients who achieved complete remission, 10 still remain free of any evidence of disease. The factor that best predicted for response to IMVP-16 was the quality of the remission achieved on front-line therapy. In view of the poor prognosis associated with recurrent lymphoma, the results obtained with this study are considered most encouraging. Patients with recurrent lymphoma can be successfully salvaged by the use of this combination regimen, especially if introduced early after relapse or preferably before progressive disease develops.

Thirty previously treated adults with lymphoma received AMSA as single agent therapy. All patients had previously received adriamycin- containing chemotherapy regimens and either failed to respond initially or responded but subsequently relapsed. The dose used was 40 mg/sq m.i.v. daily x3. For patients with compromised marrow reserve or elevated bilirubin, a 25% reduction was used. Ten of 30 patients achieved an objective response (3 CR, 3 PR, and 4 less than PR). Of the 3 patients achieving a complete remission, 2 with histiocytic lymphoma remain in remission and are currently off treatment at 14+ and 18+ mo. The response rate to AMSA was found to correlate with the type of response to frontline therapy and also with the number of previous relapses. Complete remissions on AMSA were only seen in patients who had achieved a CR on frontline treatment and who were treated on their first relapse. AMSA is an active drug against malignant lymphoma and deserves further investigation.