Treatment of relapsed non-hodgkin's lymphomas with dexamethasone, high-dose cytarabine, and cisplatin before marrow transplantation

Oliver W. Press, Robert B Livingston, Joanne Mortimer, Carolyn Collins, Fred Appelbaum

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Abstract

Combination chemotherapy is capable of curing many patients with newly diagnosed intermediate- and high-grade non-Hodgkin's lymphomas (NHL), but treatment of relapsed NHL remains problematic. Bone marrow transplantation (BMT) offers the best chance for disease-free survival, but interim chemotherapy is often necessary while awaiting BMT, especially for patients with bulky disease. We report here 39 patients (median age, 44 years) who failed primary therapy with doxorubicin-based regimens and subsequently were treated with one to six cycles of dexamethasone, 40 mg intravenous (IV) every day on days 1 to 4, cisplatin 100 mg/m2 by continuous infusion on day 1, and cytarabine 2 g/m2 IV every 12 hours x two doses on day 2 (DHAP) before the planned BMT. Histologies included 16 diffuse large-cell, six diffuse mixed, five diffuse small-cleaved, four lymphoblastic, and eight other. Twenty-eight patients had stage IV disease, 13 had B symptoms, and 20 had an elevated lactate dehydrogenase (LDH). Patients had been treated with a median of three previous chemotherapy regimens. Sixty-one percent of patients had high tumor burdens according to the MD Anderson criteria. Objective responses to DHAP were seen in 26 patients (67%) including nine complete responses (CRs) (23%) and 17 partial responses (PRs) (44%), and responses lasted a median of 7.5 months. Myelosuppression was the major toxicity, but there were no treatment-related deaths. To date, 17 patients have undergone subsequent BMT with a projected 3-year disease-free survival of 15%. We conclude that the DHAP regimen is effective short-term salvage therapy for relapsed NHL patients, but the long-term prognosis of multiply relapsed patients remains poor.

Original languageEnglish (US)
Pages (from-to)423-431
Number of pages9
JournalJournal of Clinical Oncology
Volume9
Issue number3
StatePublished - 1991
Externally publishedYes

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Cytarabine
Non-Hodgkin's Lymphoma
Dexamethasone
Cisplatin
Transplantation
Bone Marrow
Bone Marrow Transplantation
Therapeutics
Disease-Free Survival
Drug Therapy
Salvage Therapy
Combination Drug Therapy
Tumor Burden
L-Lactate Dehydrogenase
Doxorubicin
Histology

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Treatment of relapsed non-hodgkin's lymphomas with dexamethasone, high-dose cytarabine, and cisplatin before marrow transplantation. / Press, Oliver W.; Livingston, Robert B; Mortimer, Joanne; Collins, Carolyn; Appelbaum, Fred.

In: Journal of Clinical Oncology, Vol. 9, No. 3, 1991, p. 423-431.

Research output: Contribution to journalArticle

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