ifosfamide + etoposide + cytarabine + methotrexate

A combination chemotherapy regimen consisting of ifosfamide, etoposide, cytarabine, and methotrexate used primarily as salvage therapy for refractory or relapsed non-Hodgkin's lymphoma (NHL)[1][2][4]. This combination therapy serves a dual purpose: to reduce tumor burden and to facilitate peripheral blood stem cell (PBSC) collection prior to transplantation[1]. ## Efficacy and Clinical Outcomes In clinical studies, the IVAM regimen has demonstrated significant efficacy in treating relapsed or refractory NHL. In one study involving 31 patients (17 with relapsed NHL and 14 with refractory NHL), the treatment resulted in: - 61% complete response rate - 26% partial response rate - 13% non-response rate[1] The overall survival rate at 4 years was 37% for the entire group (95% confidence interval: 22-55)[1]. The regimen also successfully enabled PBSC harvest in 94% of patients, making subsequent transplantation possible for most participants[1]. ## Dosing Protocol The standard IVAM regimen consists of: - Ifosfamide: 1,500 mg/m² daily for 5 days (with mesna for uroprotection) - Etoposide: 150 mg/m² daily for 3 days - Cytarabine: 100 mg/m² daily for 3 days - Methotrexate: 3 g/m² on Day 5 (with leucovorin rescue)[1][2] ## Toxicity Profile The primary toxicity associated with IVAM is myelosuppression, though the regimen is generally considered to have acceptable toxicity levels without treatment-related deaths in the main studies[1]. The ability to collect stem cells despite this myelosuppression is a notable advantage of this protocol. ## Similar Combination Regimens It's worth noting that there are several related combination regimens that use some of these agents: 1. VIA (etoposide, ifosfamide, cytarabine) - Used as salvage treatment for primary central nervous system lymphoma (PCNSL)[3] 2. PIE (cisplatin, ifosfamide, etoposide) - Used for non-small cell lung cancer and small cell lung cancer[6][9] 3. Ifosfamide/etoposide combination - Used for recurrent malignant solid tumors in children[10] 4. IMVP-16 (ifosfamide, methotrexate, VP-16/etoposide) - Used for patients with lymphoma who have relapsed after initial combination chemotherapy[5]

Other names

ifosfamide + etoposide + cytarabine + methotrexateIVAM regimenIVAM chemotherapy