title: High dose salvage therapy with dose intensive cyclophosphamide, etoposide and cisplatin may increase transplant rates for relapsed/refractory aggressive non-Hodgkin lymphoma.
abstract: Only one-quarter to one-third of patients with relapsed/refractory aggressive non-Hodgkin lymphoma (r/r-aNHL) treated with common salvage chemotherapy regimens and autologous stem cell transplant (ASCT) achieve 5-year progression-free survival (PFS). Worse outcomes have been reported after failure of prior rituximab-containing induction, initial time to progression (TTP) < 1 year or age-adjusted International Prognostic Index (aaIPI) = 2-3 at relapse. In Calgary, we have treated patients with r/r-aNHL with dose-intensive cyclophosphamide 5.25 g/m(2), etoposide 1.05 g/m(2) and cisplatin 105 mg/m(2) (DICEP) for both re-induction therapy and autologous blood stem cell mobilization. In this study we retrospectively analyzed 113 consecutive transplant-eligible patients with r/r-aNHL who received one cycle of DICEP (n = 93) or R-DICEP (n = 20) from 1995 to 2009. Patient characteristics included: median age = 49 years (22-69); TTP < 1 year = 85; elevated lactate dehydrogenase (LDH) = 60; Eastern Cooperative Oncology Group performance status (ECOG) 2-4 = 42; aaIPI 2-3 = 59; bulk > 10 cm = 26, prior rituximab = 27. The median number of CD34 + cells collected was 19 × 10(6)/kg (0.3-142), 83.5% responded and 90% (102) proceeded to ASCT. The 5-year PFS rate was 42% for all patients, 32% for those with relapse aaIPI = 2-3, 35% for initial TTP < 1 year and 56% for those who failed initial rituximab induction. In conclusion, (R)DICEP is an effective re-induction regimen for r/r-aNHL, leading to excellent stem cell mobilization, a high chance of proceeding to ASCT and encouraging long-term PFS rates.
authors.affiliation: Departments of Oncology and Medicine, University of Calgary and Tom Baker Cancer Centre , Calgary, AB , Canada.
authors.forename: Archana
authors.initials: A
authors.lastname: Vijay
authors.forename: Qiuli
authors.initials: Q
authors.lastname: Duan
authors.forename: Jan-Willem
authors.initials: JW
authors.lastname: Henning
authors.forename: Peter
authors.initials: P
authors.lastname: Duggan
authors.forename: Andrew
authors.initials: A
authors.lastname: Daly
authors.forename: Mona
authors.initials: M
authors.lastname: Shafey
authors.forename: Nizar J
authors.initials: NJ
authors.lastname: Bahlis
authors.forename: Douglas Allan
authors.initials: DA
authors.lastname: Stewart
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D002945:Cisplatin / Q000009:adverse effects / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000009:adverse effects / Q000627:therapeutic use; D018450:Disease Progression; D005047:Etoposide / Q000009:adverse effects / Q000627:therapeutic use; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000628:therapy; D008875:Middle Aged; D012008:Recurrence; D016879:Salvage Therapy; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005047:Etoposide; D003520:Cyclophosphamide; D002945:Cisplatin