Cytosine arabinoside and etoposide (CARE) in relapsed and refractory non-Hodgkin's lymphoma.
Twelve patients with relapsed or refractory non-Hodgkin's lymphoma (NHL) were treated with a 5 day protocol of high dose cytosine arabinoside 3 g/m2 and etoposide 200 mg/m2 (CARE) daily for 4 days for either 1 or 2 cycles together with alternating intrathecal cytosine arabinoside and methotrexate. Seven men and 5 women aged 18 to 65 years (median age 47.5 years) have received a total of 19 cycles. Six patients had Stage III and 6 had Stage IV disease, all with marrow involvement. Three patients had diffuse small lymphocytic NHL, 3 had diffuse large cell NHL, 3 had diffuse small cleaved NHL and 3 remaining patients had diffuse mixed small and large cell NHL, lymphoblastic NHL and Burkitt's. Six patients (50%) achieved complete remission (3-44 months), four of whom subsequently underwent successful autologous bone marrow transplantation and a fifth has had marrow harvested in preparation for ABMT. One patient achieved partial remission and 5 patients had no response to CARE. Ten patients had nadir granulocyte counts less than 0.5 x 10(9)/l and all required red cell (range 2-11 units) and platelet (range 6-130 units) transfusions. The platelet nadir was less than 20 x 10(9)/l in all patients. One patient with refractory disease succumbed to pulmonary haemorrhage while three other patients developed reversible toxicity with serve mucositis, prolonged diarrhoea and acute renal failure. One patient with refractory disease died with a progressive neuropathy.