Rituximab plus ASHAP for the treatment of patients with relapsed or refractory aggressive non-Hodgkin’s lymphoma: a single-centre study of 20 patients
- 205 Downloads
The anti-CD20 antibody rituximab improves the results of first-line therapy in aggressive non-Hodgkin’s lymphoma (NHL) of B cell lineage. The purpose of this retrospective study was to evaluate its efficacy and toxicity in combination with the doxorubicine, methylprednisolone, high-dose cytarabine, cisplatin (ASHAP) protocol, an established treatment regimen for relapsed or refractory aggressive NHL. After a median of four cycles, 9 of 20 patients treated achieved a complete remission and 6 a partial remission, resulting in a total response rate of 75%. Remissions were not only seen in patients with relapsed lymphomas but also in patients with primary refractory or transformed indolent lymphomas. The outcome in cases with an international prognostic index score ≥2 was poor. Five of 15 responders received consolidating high-dose therapy with autologous stem cell transplantation. All of them are in ongoing remission. The main toxicity was myelosuppression, with neutropenias or thrombocytopenias of World Health Organization (WHO) grades III or IV developing in more than 90% of the cycles. There was one therapy-related death due to neutropenic sepsis. Non-hematologic toxicity was generally mild. At the time of analysis, six patients have died. After a median observation time of 17.5 months, the 2-year overall survival rate is 62%. ASHAP plus rituximab is an active and well-tolerated salvage protocol for patients with relapsed or refractory aggressive NHL, which compares favourably with other immuno-chemotherapy regimens, especially in patients with primary refractory or transformed indolent lymphomas.
KeywordsASHAP Anti-CD20 antibody rituximab Salvage chemotherapy Non-Hodgkin’s lymphoma Relapse
This paper is dedicated to Professor Günter Brittinger on the occasion of his 75th birthday.
- 7.Velasquez W, Dunphy F, Petruska PJ, Adkins D, Broun GO Jr, Spitzer G (1995) ASHAP with or without ABMT for high risk non-Hodgkin’s lymphoma (NHL). Proc Am Soc Clin Oncol 14:387 (Abstr 1205)Google Scholar
- 8.Velasquez W, Dunphy F, Santillana S, Adkins D, Browers C, Broun GO Jr, Petruska PJ, Spitzer G (1993) ASHAP, an effective treatment for relapsing and refractory Hodgkin’s disease (HD) and non-Hodgkin’s lymphoma (NHL). Blood 82(Suppl 1):138a (Abstr 538)Google Scholar
- 14.Venugopal P, Gretory S, Showel J et al (2004) Rituximab (Rituxan) combined with ESHAP chemotherapy is highly active in relapsed/refractory aggressive non-Hodgkin’s lymphoma. Blood (ASH Annual Meeting Abstracts) 104:4636, (Abstract)Google Scholar
- 15.Hicks L, Buckstein R, Piliotis E et al (2004) Rituximab + ESHAP as salvage chemotherapy for relapsed/refractory aggressive non-Hodgkins lymphoma: a phase II trial. Blood (ASH Annual Meeting Abstracts) 104:5230, (Abstract)Google Scholar
- 16.Mey U, Strehl J, Orlopp KS et al (2004) A phase II trial of dexamethasone, high-dose cytarabine, and cisplatin (DHAP) in combination with rituximab as salvage treatment for patients with refractory or relapsed aggressive non-Hodgkin’s lymphoma. Blood (ASH Annual Meeting Abstracts) 104:4618, (Abstract)Google Scholar
- 17.Rupolo M, Spina M, Michieli M et al (2004) R-DHAOX as salvage regimen in patients (pts) with relapsed/resistant non-Hodgkins lymphoma (NHL). Blood (ASH Annual Meeting Abstracts) 104:1323, (Abstract)Google Scholar
- 19.Gnaoui T, Dupuis J, Joly B et al (2004) Rituximab, gemcitabine and oxaliplatin (R-GEMOX): a promising regimen for refractory/relapsed B-cell lymphoma. Blood (ASH Annual Meeting Abstracts) 104:2483, (Abstract)Google Scholar