title: Prognostic relevance of DHAP dose-density in relapsed Hodgkin lymphoma: an analysis of the German Hodgkin-Study Group.
abstract: Only 50% of patients with relapsed Hodgkin lymphoma (HL) can be cured with intensive induction chemotherapy, followed by high-dose chemotherapy (HDCT) and autologous stem cell transplant (ASCT). Based on the results of the HDR2 trial two courses of DHAP and subsequent HDCT/ASCT are the current standard of care in relapsed HL. In order to assess the prognostic relevance of DHAP dose density, we performed a retrospective multivariate analysis of the HDR2 trial (N=266). In addition to four risk factors (early or multiple relapse, stage IV disease or anemia at relapse, and grade IV hematotoxicity during the first cycle of DHAP) a delayed start of the second cycle of DHAP>day 22 predicted a significantly poorer progression-free survival (PFS, p=0.0356) and overall survival (OS, p=0.0025). In conclusion, our analysis strongly suggests that dose density of DHAP has a relevant impact on the outcome of relapsed HL patients.
authors.affiliation: a Internal Medicine I, German Hodgkin Study Group , University Hospital of Cologne , Cologne , Germany ;
authors.forename: Stephanie
authors.initials: S
authors.lastname: Sasse
authors.affiliation: a Internal Medicine I, German Hodgkin Study Group , University Hospital of Cologne , Cologne , Germany ;
authors.forename: Magdalena
authors.initials: M
authors.lastname: Alram
authors.affiliation: a Internal Medicine I, German Hodgkin Study Group , University Hospital of Cologne , Cologne , Germany ;
authors.forename: Horst
authors.initials: H
authors.lastname: Müller
authors.affiliation: b University Hospital Brno and Faculty of Medicine , Masaryk University , Brno , Czech Republic ;
authors.forename: Lenka
authors.initials: L
authors.lastname: Smardová
authors.affiliation: c Department of Hematology and Oncology , Hospital of Oldenburg , Oldenburg , Germany ;
authors.forename: Bernd
authors.initials: B
authors.lastname: Metzner
authors.affiliation: d Clinic III for Internal Medicine , University Hospital of Ulm , Ulm , Germany ;
authors.forename: Hartmut
authors.initials: H
authors.lastname: Doehner
authors.affiliation: e Department of Hematology and Oncology , University Hospital of Magdeburg , Magdeburg , Germany ;
authors.forename: Thomas
authors.initials: T
authors.lastname: Fischer
authors.affiliation: f Department of Hematology and Oncology , University Hospital of Leipzig , Leipzig , Germany ;
authors.forename: Dietger W
authors.initials: DW
authors.lastname: Niederwieser
authors.affiliation: g Department of Hematology, Oncology , Asklepios Clinic St. Georg , Hamburg , Germany ;
authors.forename: Norbert
authors.initials: N
authors.lastname: Schmitz
authors.affiliation: h Department of Oncology/Hematology , Klinikum Nuernberg Nord , Nuernberg , Germany ;
authors.forename: Kerstin
authors.initials: K
authors.lastname: Schäfer-Eckart
authors.affiliation: i Department of Hematology , Radboud University Medical Center , Nijmegen , Netherlands ;
authors.forename: John M M
authors.initials: JM
authors.lastname: Raemaekers
authors.affiliation: j Clinic I for Internal Medicine , Helios Clinic Wuppertal , Wuppertal , Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Schmalz
authors.affiliation: a Internal Medicine I, German Hodgkin Study Group , University Hospital of Cologne , Cologne , Germany ;
authors.forename: Bastian V
authors.initials: BV
authors.lastname: Tresckow
authors.affiliation: a Internal Medicine I, German Hodgkin Study Group , University Hospital of Cologne , Cologne , Germany ;
authors.forename: Andreas
authors.initials: A
authors.lastname: Engert
authors.affiliation: a Internal Medicine I, German Hodgkin Study Group , University Hospital of Cologne , Cologne , Germany ;
authors.forename: Peter
authors.initials: P
authors.lastname: Borchmann
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D002945:Cisplatin / Q000009:adverse effects / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003561:Cytarabine / Q000009:adverse effects / Q000627:therapeutic use; D003907:Dexamethasone / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D005858:Germany; D018380:Hematopoietic Stem Cell Transplantation; D006689:Hodgkin Disease / Q000188:drug therapy* / Q000401:mortality* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant; D012008:Recurrence; D019233:Retreatment; D016879:Salvage Therapy; D016896:Treatment Outcome
chemical_list: D003561:Cytarabine; D003907:Dexamethasone; D002945:Cisplatin
keywords: DHAP; dose density; hematotoxicity; outcome; relapsed Hodgkin lymphoma