Modified DHAP regimen in the salvage treatment of refractory or relapsed lymphomas
| Autor: | Frank Kroschinsky, Michael Kramer, Denise Röllig, Barbara Riemer, Johannes Schetelig, Gerhard Ehninger, Mathias Hänel, Martin Bornhäuser, Rainer Ordemann |
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| Rok vydání: | 2019 |
| Předmět: |
0301 basic medicine
Adult Male Cancer Research medicine.medical_specialty Adolescent Lymphoma DHAP Regimen Gastroenterology Dexamethasone Drug Administration Schedule 03 medical and health sciences Young Adult 0302 clinical medicine DHAP Internal medicine Antineoplastic Combined Chemotherapy Protocols medicine Humans Aged Retrospective Studies Cisplatin Salvage Therapy business.industry Cytarabine General Medicine Middle Aged medicine.disease Transplantation Regimen 030104 developmental biology Oncology 030220 oncology & carcinogenesis Female Neoplasm Recurrence Local business Febrile neutropenia medicine.drug |
| Zdroj: | Journal of cancer research and clinical oncology. 145(12) |
| ISSN: | 1432-1335 |
| Popis: | The combination of dexamethasone, high-dose cytarabine, and cisplatin (DHAP) is an established salvage regimen for lymphoma patients. We hypothesized that a modified administration schedule for cisplatin and cytarabine results in lower toxicity and improved efficacy. We retrospectively analysed 119 patients with relapsed or refractory, aggressive, or indolent B-cell lymphomas, mantle-cell lymphomas, peripheral T-cell lymphomas, or Hodgkin’s lymphomas who were treated with the modified DHAP (mDHAP) regimen (dexamethasone 40 mg 15 min-i.v. infusion, days 1–4; cytarabine 2 × 0.5 g/m2 1 h-i.v. infusion, days 1–4; cisplatin 25 mg/m2 24 h-i.v. infusion, days 1–4). Responding and eligible patients underwent stem-cell transplantation. In total, 185 treatment cycles were evaluable. Severe myelosuppression was the main toxicity occurring in 90% of the cycles. Febrile neutropenia or documented infection was found in less than 40%. Two patients died related to treatment (TRM, 1.7%). Nephrotoxicity did not exceed CTC grade 3, which occurred in four cycles only (2.2%). Complete (CR) or partial (PR) responses after mDHAP were documented in 16% and 39% (overall response rate 55%). Harvest of autologous stem cells was successful in 94 (79%) patients and 85 patients (71%) proceeded to stem-cell transplantation. The median overall and progression-free survival was 50.8 and 25.8 months. An improvement in efficacy could not be observed after modified DHAP regimen; however, manageable toxicity and reduced renal complications suggest further investigation. The study, however, also underlines the need for new concepts in the management of advanced and high-risk lymphomas. |
| Databáze: | OpenAIRE |
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