BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
BACKGROUND: The combination of dexamethasone, high-dose cytarabine, and cisplatin (DHAP) is an established salvage regimen for lymphomapatients. We hypothesized that a modified administration schedule for cisplatin and cytarabine results in lower toxicity and improved efficacy. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
Authors: Wolfgang Hiddemann; Michael Kneba; Martin Dreyling; Norbert Schmitz; Eva Lengfelder; Rudolf Schmits; Marcel Reiser; Bernd Metzner; Harriet Harder; Susanna Hegewisch-Becker; Thomas Fischer; Martin Kropff; Hans-Edgar Reis; Mathias Freund; Bernhard Wörmann; Roland Fuchs; Manfred Planker; Jörg Schimke; Hartmut Eimermacher; Lorenz Trümper; Ali Aldaoud; Reza Parwaresch; Michael Unterhalt Journal: Blood Date: 2005-08-25 Impact factor: 22.113
Authors: Paul A Harris; Robert Taylor; Robert Thielke; Jonathon Payne; Nathaniel Gonzalez; Jose G Conde Journal: J Biomed Inform Date: 2008-09-30 Impact factor: 6.317
Authors: Michael Crump; John Kuruvilla; Stephen Couban; David A MacDonald; Vishal Kukreti; C Tom Kouroukis; Morel Rubinger; Rena Buckstein; Kevin R Imrie; Massimo Federico; Nicola Di Renzo; Kang Howson-Jan; Tara Baetz; Leonard Kaizer; Michael Voralia; Harold J Olney; A Robert Turner; Jonathan Sussman; Annette E Hay; Marina S Djurfeldt; Ralph M Meyer; Bingshu E Chen; Lois E Shepherd Journal: J Clin Oncol Date: 2014-09-29 Impact factor: 44.544
Authors: M Hänel; N Kröger; F Kroschinsky; J Birkmann; A Hänel; R Herbst; R Naumann; K Friedrichsen; G Ehninger; A R Zander; F Fiedler Journal: J Cancer Res Clin Oncol Date: 2001 Impact factor: 4.553
Authors: M Hänel; N Kröger; M M Hoffknecht; S O Peters; B Metzner; F Fiedler; D Braumann; J C Schubert; H J Illiger; A Hänel; W H Krüger; W Zeller; H J Weh; D K Hossfeld; A R Zander Journal: Ann Hematol Date: 2000-06 Impact factor: 3.673
Authors: A Josting; M Sieniawski; J-P Glossmann; O Staak; L Nogova; N Peters; M Mapara; B Dörken; Y Ko; B Metzner; J Kisro; V Diehl; A Engert Journal: Ann Oncol Date: 2005-06-06 Impact factor: 32.976
Authors: W S Velasquez; P McLaughlin; S Tucker; F B Hagemeister; F Swan; M A Rodriguez; J Romaguera; E Rubenstein; F Cabanillas Journal: J Clin Oncol Date: 1994-06 Impact factor: 44.544