title: ASHAP--an effective salvage therapy for recurrent and refractory malignant lymphomas.
abstract: BACKGROUND
  This study was performed to examine the efficacy and toxicity of the combination of adriamycin (ADR), methylprednisolone (solumedrol), cytarabine (Ara-C), and cisplatin (CDDP) in patients with recurrent and refractory malignant lymphomas.
  
  
  METHODS
  Sixty-five patients with Hodgkin's disease (HD) (n=14) or non-Hodgkin's lymphomas (NHL) (n = 51) were enrolled in the study. The ASHAP therapy consisted of ADR (40 mg/m2 by continuous infusion (CI) over 96 h), methylprednisolone (500 mg i.v., days 1-5), Ara-C (2 g/m2 as a 2-h infusion on day 5), and CDDP (100 mg/m2 by CI over 96 h).
  
  
  RESULTS
  Twenty-five patients (38%) achieved complete remission (CR) and 20 (31%) were taken into partial remission (PR) for an overall response rate of 69%. Thirty-two patients with CR or PR following ASHAP underwent high-dose therapy (HDT) with subsequent hematopoietic stem cell transplantation. After a median follow-up of 52 months, 13 patients are in continuous CR (CCR), the 3-year event-free survival (EFS) was 30% for responders and 21% for all patients. The median overall survival (OS) was 12 months (range 0-70 months), and the OS rate after 3 years was 32%. Unfavorable prognostic factors for EFS and OS by univariate analysis were an elevated value of the serum lactate dehydrogenase and refractory lymphoma. The most frequently observed side effects following ASHAP were leukocytopenia and thrombocytopenia of World Health Organization (WHO) grades III/IV in approximately 80% of all courses. Non-hematological toxicities such as gastrointestinal side effects, infections, mucositis, renal and neurotoxicity occurred more rarely and reached WHO grades III/IV only occasionally. No treatment-related mortality with ASHAP was observed.
  
  
  CONCLUSIONS
  ASHAP is an effective and moderately toxic salvage therapy for patients with recurrent or refractory HD and NHL. The results in patients responding to ASHAP and afterwards undergoing HDT with stem cell support are comparable with other established protocols and indicate an improvement in survival if HDT is carried out as intensification.
authors.affiliation: Department of Hematology, Clinic of Internal Medicine III, Chemnitz, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Hänel
authors.forename: N
authors.initials: N
authors.lastname: Kröger
authors.forename: M M
authors.initials: MM
authors.lastname: Hoffknecht
authors.forename: S O
authors.initials: SO
authors.lastname: Peters
authors.forename: B
authors.initials: B
authors.lastname: Metzner
authors.forename: F
authors.initials: F
authors.lastname: Fiedler
authors.forename: D
authors.initials: D
authors.lastname: Braumann
authors.forename: J C
authors.initials: JC
authors.lastname: Schubert
authors.forename: H J
authors.initials: HJ
authors.lastname: Illiger
authors.forename: A
authors.initials: A
authors.lastname: Hänel
authors.forename: W H
authors.initials: WH
authors.lastname: Krüger
authors.forename: W
authors.initials: W
authors.lastname: Zeller
authors.forename: H J
authors.initials: HJ
authors.lastname: Weh
authors.forename: D K
authors.initials: DK
authors.lastname: Hossfeld
authors.forename: A R
authors.initials: AR
authors.lastname: Zander
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D002945:Cisplatin / Q000008:administration & dosage; D003561:Cytarabine / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006689:Hodgkin Disease / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008776:Methylprednisolone Hemisuccinate / Q000008:administration & dosage; D008875:Middle Aged; D012008:Recurrence; D016879:Salvage Therapy; D016019:Survival Analysis
chemical_list: D003561:Cytarabine; D008776:Methylprednisolone Hemisuccinate; D004317:Doxorubicin; D002945:Cisplatin