title: Modified ESHAP as salvage chemotherapy for recurrent or refractory non-Hodgkin's lymphoma: results of a single-center study of 32 patients. Modified etoposide, methylprednisolone, cytarabine and cisplatin.
abstract: BACKGROUND
  We have evaluated the clinical efficacy and toxicity of a modified etoposide, methylprednisolone, cytarabine and cisplatin (ESHAP) chemotherapy regimen that has been used by the Hacettepe University Department of Medical Oncology (Ankara, Turkey) since 1993.
  
  
  METHODS
  Thirty-two patients (18 men and 14 women) with refractory or recurrent non-Hodgkin's lymphoma (NHL) were treated with this protocol. The median age of the patients was 39 years (range 21-66 years). Patients were hospitalized during therapy. On the first day, 2 g/m(2) cytarabine was given, followed on days 2-5 by 60 mg/m(2) etoposide, 500 mg of methylprednisolone and 25 mg/m(2) cisplatin. After two cycles of chemotherapy, clinical efficacy was assessed by clinical examination, chest radiography, ultrasonography and/or computed tomography. The complications were assessed on the basis of the World Health Organization criteria.
  
  
  RESULTS
  Nine patients (28%) had a complete response and 8 patients (25%) had a partial response. In responders, the median duration of remission was 6 months. By the end of the first year, 27% of the patients were still disease free and 66% were alive. High serum levels of lactate dehydrogenase had an adverse effect on disease-free survival, but no effect on overall survival (OS). The only unfavorable prognostic factor for OS was the presence of bulky disease. Neutropenia developed in 59% of patients, and febrile neutropenia developed in 74% of these patients, requiring hospitalization for an average of 8 days. Three patients died of neutropenia-associated sepsis despite broad-spectrum antibacterial and antifungal treatment. Thrombocytopenia was detected in 10 patients and anemia in 3 patients; among these, 7 patients with thrombocytopenia and 1 patient with anemia required transfusions.
  
  
  CONCLUSIONS
  The modified ESHAP regimen induced remission in more than half of the patients with refractory or recurrent NHL. However, the duration of remission was brief. Moreover, significant myelotoxicity was common, and the risk of treatment-related death was 9%.
authors.affiliation: Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
authors.forename: Mehmet Akif
authors.initials: MA
authors.lastname: Oztürk
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Barişta
authors.forename: M Kadri
authors.initials: MK
authors.lastname: Altundağ
authors.forename: Alev
authors.initials: A
authors.lastname: Türker
authors.forename: Suayib
authors.initials: S
authors.lastname: Yalçin
authors.forename: Ismail
authors.initials: I
authors.lastname: Celik
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Güllü
authors.forename: Nilüfer
authors.initials: N
authors.lastname: Güler
authors.forename: Yavuz
authors.initials: Y
authors.lastname: Ozişik
authors.forename: Ayşe
authors.initials: A
authors.lastname: Kars
authors.forename: Emin
authors.initials: E
authors.lastname: Kansu
authors.forename: Eşmen
authors.initials: E
authors.lastname: Baltali
authors.forename: Gülten
authors.initials: G
authors.lastname: Tekuzman
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use*; D002945:Cisplatin / Q000009:adverse effects* / Q000627:therapeutic use*; D003561:Cytarabine / Q000009:adverse effects* / Q000627:therapeutic use*; D005047:Etoposide / Q000009:adverse effects* / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy*; D008297:Male; D008775:Methylprednisolone / Q000009:adverse effects* / Q000627:therapeutic use*; D008875:Middle Aged; D012189:Retrospective Studies; D016879:Salvage Therapy; D016019:Survival Analysis
chemical_list: D003561:Cytarabine; D005047:Etoposide; D002945:Cisplatin; D008775:Methylprednisolone