Shortened and intensified MJMA: An effective salvage therapy for relapsed and refractory lymphomas and a strong mobilizer of PBSCs

There is great interest in chemotherapies for relapsed or refractory lymphomas that are both directly effective against the lymphoma and able to mobilize PBSCs for rescue after high-dose chemotherapy (HDC). Twenty-eight patients with relapsed or refractory lymphomas were treated with a shortened, intensified MJMA regimen (mitoxantrone 10 mg/m² i.v. day 1, carboplatin 200 mg/m² i.v. days 1-2, methylprednisolone 500 mg/m² i.v. days 1-3, cytarabine 2000 mg/m² i.v. day 3) for six cycles every 21 days. A median of five cycles/patient was administered. Nineteen patients had complete responses, seven partial responses and two no responses. The only remarkable toxicity was hematological. In 18 patients who were candidates for HDC, a mean of 10.45 × 10⁶ CD34/kg of patients' body weight was collected (range: 3.70-24.88 × 10⁶/kg). Eleven patients underwent transplantation, which converted two of four partial responses into complete responses. The median follow-up was 49 months. Survival parameters were not related to relapsed/refractory status or to the time from the last chemotherapy, but were related only weakly to the number of prior chemotherapies. Outpatient MJMA is a feasible and very effective salvage chemotherapy per se. The complete response rate is high and it is a powerful PBSC mobilizer.