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Modified DHAP regimen in the salvage treatment of refractory or relapsed lymphomas

  • Original Article – Clinical Oncology
  • Published:
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Abstract

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.

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Authors and Affiliations

  1. Medical Department I, Dresden University Hospital, Fetscherstr. 74, 01307, Dresden, Germany

    Frank Kroschinsky, Denise Röllig, Barbara Riemer, Michael Kramer, Rainer Ordemann, Johannes Schetelig, Martin Bornhäuser & Gerhard Ehninger

  2. Klinikum Chemnitz, Clinic for Internal Medicine III, Bürgerstr. 2, Küchwald, 09113, Chemnitz, Germany

    Mathias Hänel

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  1. Frank Kroschinsky
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  2. Denise Röllig
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  3. Barbara Riemer
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  4. Michael Kramer
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  5. Rainer Ordemann
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  8. Gerhard Ehninger
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  9. Mathias Hänel
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Correspondence to Frank Kroschinsky.

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Kroschinsky, F., Röllig, D., Riemer, B. et al. Modified DHAP regimen in the salvage treatment of refractory or relapsed lymphomas. J Cancer Res Clin Oncol 145, 3067–3073 (2019). https://doi.org/10.1007/s00432-019-03027-6

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  • DOI: https://doi.org/10.1007/s00432-019-03027-6

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