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ESHAP as salvage therapy for relapsed or refractory Hodgkin’s lymphoma

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The management of relapsed or refractory Hodgkin’s lymphoma (RR-HL) remains a challenge for hematologists and oncologists. Salvage chemotherapy followed by autologous stem cell transplantation (ASCT) is the standard of care for RR-HL. However, one of the most controversial aspects is which the best salvage protocol could be. We retrospectively analyzed 82 consecutive RR-HL who received etoposide, steroids, ara-C, and cisplatin (ESHAP) as salvage therapy followed by ASCT. Fifty percent of patients were refractory and 23 % early relapses. Overall response rate (ORR) was 67 % (50 % complete remission (CR)). Ninety one percent of patients (75/82) were transplanted. With a mean follow-up of 87 ± 53 months, the median progression-free survival (PFS) and time to tumor progression (TTP) for the whole population were 52 and 56 months, respectively, and the 5-year overall survival was 72.6 %. Achieving CR after ESHAP was associated with a longer PFS (78 vs 16 % 5-year PFS, respectively, P < 0.01) and TTP (80 vs 19 % 5-year TTP, respectively, P < 0.01). However, there were no differences for overall survival (OS) when comparing CR and partial response (PR) after ESHAP. Toxicity was low and <10 % of patients developed neutropenic fever, with no toxic deaths. Mobilization was possible in 94 % of patients. ESHAP is a safe and efficient therapeutic option for patients with RR-HL who are candidates for ASCT, since it combines a high response rate and mobilizing potential with a low toxicity profile.

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The authors thank Manuel Delgado, Manuela Salinero, and Marta García-Blázquez for their technical assistance, and Phil Mason for checking the English usage and grammar of the manuscript.

Author contribution

RG-S and MDC conceived the study. RG-S, JL, MC-C, EP-L, MVM, and LV provided the patients. JL collected data and performed the interpretation and statistical analysis. JL, RGS, and MDC wrote the paper. All authors critically reviewed the paper and approved the final version of the paper.

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The authors declare no conflicts of interest.

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Correspondence to Jorge Labrador.

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Labrador, J., Cabrero-Calvo, M., Pérez-López, E. et al. ESHAP as salvage therapy for relapsed or refractory Hodgkin’s lymphoma. Ann Hematol 93, 1745–1753 (2014).

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