title: E-SHAP: an effective treatment in selected patients with relapsed non-Hodgkin's lymphoma.
abstract: BACKGROUND
  The optimal treatment of relapsed or refractory non-Hodgkin's lymphoma is unknown. The reported encouraging results of a salvage regimen, E-SHAP (etoposide 40 mg/m2/day x 4, methyl prednisolone 500 mg daily x 4, cytosine arabinoside 2 gm/m2 one dose and cisplatinum 25 mg/m2/day x 4), at the M.D. Anderson Hospital in Texas, which resulted in a 65% response rate, could not be reproduced in the United Kingdom (0% response).
  
  
  METHODS
  Twenty-six patients with relapsed (n = 16) or refractory (n = 10) non-Hodgkin's lymphoma were treated at our Centre by a modified E-SHAP regimen (cytosine arabinoside 1 gm/m2 one dose). The treatment was intended as remission induction before BMT (n = 16), as salvage by itself (n = 5) and for palliation of symptoms (n = 5).
  
  
  RESULTS
  The overall response rate was 72% (CR = 7 and PR = 11). A comparison of Kaplan-Meier curves showed a statistically significant improvement in median relapse-free survival in patients who had previously achieved CR (p = 0.0012), no bulky disease (P = 0.0006) and no B-symptoms (P = 0.0004). The toxicity was acceptable: 8 instances of febrile neutropenia, 2 of reversible renal impairment and 2 symptomatic electrolyte abnormalities. No fatal toxicities were encountered. The median time to treatment failure was 191 days and median overall survival was 190 days.
  
  
  CONCLUSIONS
  E-SHAP is an active combination chemotherapy when used as a salvage regimen or for remission induction before bone marrow transplantation in selected patients with relapsed non-Hodgkin's lymphoma. Patients who previously achieved CR, with low tumour burden and no B-symptoms are the best candidates for this treatment. It has a limited palliative effect.
authors.affiliation: Department of Oncology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia.
authors.forename: A A
authors.initials: AA
authors.lastname: Ezzat
authors.forename: F
authors.initials: F
authors.lastname: Khalifa
authors.forename: J
authors.initials: J
authors.lastname: Berry
authors.forename: B
authors.initials: B
authors.lastname: Khan
authors.forename: M A
authors.initials: MA
authors.lastname: Raja
authors.forename: A
authors.initials: A
authors.lastname: Abdel-Warith
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D002945:Cisplatin / Q000008:administration & dosage; D003561:Cytarabine / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced; D012008:Recurrence; D012074:Remission Induction; D016879:Salvage Therapy; D015996:Survival Rate; D013921:Thrombocytopenia / Q000139:chemically induced
chemical_list: D003561:Cytarabine; D005047:Etoposide; D002945:Cisplatin; D008775:Methylprednisolone