Publication: Retrospective Analysis of Toxicity Profiles of Two Platinum-Based Salvage Regimens in Relapsed/ Refractory Lymphoma: DHAP versus ESHAP
Abstract
Günümüzde relaps/refrakter lenfomalı olgularda sık kullanılan kurtarma kemoterapi rejimleri arasında ESHAP, ICE, DHAP gibi platin temelli ve ifosfamid temelli rejimler yer almaktadır. Kurtarma rejimlerinin en önemli yan etkileri hematolojik toksisiteleridir. Relaps/refrakter lenfomalı olgularda sık kullanılan farklı iki platin temelli kemoterapi rejimini hematolojik ve hematolojik olmayan toksisiteler açısından incelemek amaçlanmıştır. Ocak 2000 ile Temmuz 2010 tarihleri arasında HL ve NHL tanısı ile kurtarma kemoterapisi olarak DHAP ve ESHAP uygulanan 51 hasta (33 ESHAP, 18 DHAP) değerlendirildi. Bu hastalara toplam 153 siklus (91 siklus ESHAP, 62 siklus DHAP) kurtarma kemoterapisi uygulandı. Hematoloji Bilim Dalı kayıtları, hastane arşivi ve elektronik hasta dosya sistemi kullanılarak retrospektif inceleme yapıldı. DHAP uygulanmış olmak renal toksisite gelişimi (OR= 23.6, p= 0.03) ve trombosit transfüzyonu gereksinimi (OR: 7.55, p= 0.03) açısından bağımsız bir risk faktörü saptandı. Genel yanıt oranı DHAP grubunda anlamlı olarak daha yüksek iken (%86.7 ve %48.3, p= 0.03) ortanca sağkalım açısından iki grup arasında anlamlı bir fark saptanmadı. DHAP rejiminde yanıt oranları yüksek olmasına rağmen sağkalım avantajının olmadığı gözlenmiştir. Hematolojik ve hematolojik olmayan toksisite profili benzer olmasına rağmen özellikle trombosit transfüzyonu gereksinimi ve potansiyel renal toksisite DHAP uygulanması planlanan hastalarda göz önünde bulundurulmalıdır.
Platinum- or ifosfamide-based salvage therapies such as DHAP, ICE and ESHAP are frequently used regimens in relapsed/refractory lymphomas. The most important adverse effect of salvage therapies is hematologic toxicity. The aim of this study to compare the hematologic and non-hematological toxicity profiles of two different platinum-based salvage chemotherapy regimens used in relapsed/refractory lymphoma. We evaluated 51 patients with HL and NHL who were treated with DHAP and ESHAP regimens (n= 18 for DHAP and n= 33 for ESHAP) between January 2000 and July 2010. These patients had received a total of 153 cycles (62 DHAP and 91 ESHAP). Data were retrospectively collected from patients' chart records and electronic patient inventory. Receiving DHAP regimen was found to be an independent risk factor for renal toxicity (Odds ratio [OR]= 23.6, p= 0.03) and independent predictor of platelet transfusion requirement (OR: 7.55, p= 0.03). Overall response was significantly higher in DHAP group (86.7% vs 48.3%, p= 0.03) but there was no significant difference between two groups in terms of median survival. DHAP regimen is associated with higher response rates but has no survival advantage. Although the hematologic and non-hematologic toxicity profiles were similar, increased risk for renal toxicity and platelet transfusion requirement should be considered for patients planned to receive DHAP regimen.
Platinum- or ifosfamide-based salvage therapies such as DHAP, ICE and ESHAP are frequently used regimens in relapsed/refractory lymphomas. The most important adverse effect of salvage therapies is hematologic toxicity. The aim of this study to compare the hematologic and non-hematological toxicity profiles of two different platinum-based salvage chemotherapy regimens used in relapsed/refractory lymphoma. We evaluated 51 patients with HL and NHL who were treated with DHAP and ESHAP regimens (n= 18 for DHAP and n= 33 for ESHAP) between January 2000 and July 2010. These patients had received a total of 153 cycles (62 DHAP and 91 ESHAP). Data were retrospectively collected from patients' chart records and electronic patient inventory. Receiving DHAP regimen was found to be an independent risk factor for renal toxicity (Odds ratio [OR]= 23.6, p= 0.03) and independent predictor of platelet transfusion requirement (OR: 7.55, p= 0.03). Overall response was significantly higher in DHAP group (86.7% vs 48.3%, p= 0.03) but there was no significant difference between two groups in terms of median survival. DHAP regimen is associated with higher response rates but has no survival advantage. Although the hematologic and non-hematologic toxicity profiles were similar, increased risk for renal toxicity and platelet transfusion requirement should be considered for patients planned to receive DHAP regimen.