Salvage therapy with an outpatient DHAP schedule followed by PBSC transplantation in 79 lymphoma patients: an intention to mobilize and transplant analysis.

Chemotherapy followed by autologous transplantation may be an efficient salvage treatment in malignant lymphomas. We investigated the feasibility, tolerability and efficacy of an outpatient schedule of dexamethasone, cytarabine and cisplatin (DHAP), followed by peripheral blood progenitor cell autografting as salvage treatment in patients with high grade (HG), low grade (LG) non-Hodgkin's lymphoma (NHL) and Hodgkin's Disease (HD). A total of 159 DHAP courses (median: 2, range: 1-5), was administered on outpatient basis to 79 patients (31 LG-NHL, 28 HG-NHL and 20 HD), with the intention to mobilize and to transplant. A successful collection was not achieved in 40% LG-NHL, 10% HD and 20% HG-NHL patients. The risk to fail the collection was significantly related to the number of previous chemotherapy courses (>6) (P = 0.005, RR = 1.4), to the pretransplant status (P = 0.04, RR = 13.5) and to the previous fludarabine administration (P = 0.01, RR = 20). High dose therapy (HDT) was feasible in 60 patients (76%). The overall treatment related mortality was 3.8%. The overall response rate (ORR) was 81% with a 57.6% overall survival (OS) at 62 months (95% CI: 45-69.3%) and a progression free survival (PFS) of 42% at 74 months (95% CI: 26.7-58%). The diagnosis of HG-NHL and the non-response to DHAP resulted to reduce respectively the OS (P = 0.007, RR = 2.8) and PFS probability (P = 0.01, RR = 4.1). In conclusion this outpatient schedule of DHAP is a well tolerated, efficient salvage and mobilizing regimen not only in HG-NHL, but also in LG-NHL and in HD. Randomized studies are needed to better define the role of DHAP in LG-NHL and HD patients.