title: ESHAP as salvage therapy for relapsed or refractory Hodgkin's lymphoma.
abstract: The management of relapsed or refractory Hodgkin's lymphoma (RR-HL) remains a challenge for hematologists and oncologists. Salvage chemotherapy followed by autologous stem cell transplantation (ASCT) is the standard of care for RR-HL. However, one of the most controversial aspects is which the best salvage protocol could be. We retrospectively analyzed 82 consecutive RR-HL who received etoposide, steroids, ara-C, and cisplatin (ESHAP) as salvage therapy followed by ASCT. Fifty percent of patients were refractory and 23 % early relapses. Overall response rate (ORR) was 67 % (50 % complete remission (CR)). Ninety one percent of patients (75/82) were transplanted. With a mean follow-up of 87 ± 53 months, the median progression-free survival (PFS) and time to tumor progression (TTP) for the whole population were 52 and 56 months, respectively, and the 5-year overall survival was 72.6 %. Achieving CR after ESHAP was associated with a longer PFS (78 vs 16 % 5-year PFS, respectively, P < 0.01) and TTP (80 vs 19 % 5-year TTP, respectively, P < 0.01). However, there were no differences for overall survival (OS) when comparing CR and partial response (PR) after ESHAP. Toxicity was low and <10 % of patients developed neutropenic fever, with no toxic deaths. Mobilization was possible in 94 % of patients. ESHAP is a safe and efficient therapeutic option for patients with RR-HL who are candidates for ASCT, since it combines a high response rate and mobilizing potential with a low toxicity profile.
authors.affiliation: Department of Hematology, University Hospital of Salamanca, Paseo de San Vicente, 58-182, 37007, Salamanca, Spain, jorge_labrador@hotmail.com.
authors.forename: Jorge
authors.initials: J
authors.lastname: Labrador
authors.forename: Mónica
authors.initials: M
authors.lastname: Cabrero-Calvo
authors.forename: Estefanía
authors.initials: E
authors.lastname: Pérez-López
authors.forename: María Victoria
authors.initials: MV
authors.lastname: Mateos
authors.forename: Lourdes
authors.initials: L
authors.lastname: Vázquez
authors.forename: María Dolores
authors.initials: MD
authors.lastname: Caballero
authors.forename: Ramón
authors.initials: R
authors.lastname: García-Sanz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002330:Carmustine / Q000008:administration & dosage; D002648:Child; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D003131:Combined Modality Therapy; D003561:Cytarabine / Q000008:administration & dosage / Q000009:adverse effects; D004341:Drug Evaluation; D005047:Etoposide / Q000008:administration & dosage / Q000009:adverse effects; D064147:Febrile Neutropenia / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D019650:Hematopoietic Stem Cell Mobilization; D006689:Hodgkin Disease / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000532:radiotherapy / Q000628:therapy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008558:Melphalan / Q000008:administration & dosage; D008775:Methylprednisolone / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D016879:Salvage Therapy; D033581:Stem Cell Transplantation; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D003561:Cytarabine; D005047:Etoposide; D002945:Cisplatin; D008558:Melphalan; D002330:Carmustine; D008775:Methylprednisolone