title: Carboplatin instead of cisplatin in combination with dexamethasone, high-dose cytarabine with or without rituximab (DHAC+/-R) is an effective treatment with low toxicity in Hodgkin's and non-Hodgkin's lymphomas.
abstract: The DHAP regimen (high-dose cytarabine in combination with dexamethasone and cisplatin) with or without rituximab (DHAP+/-R) is one of the most common regimens in daily practice. It is considered the standard treatment for relapse or refractory Hodgkin's and non-Hodgkin's lymphoma (NHL). Cisplatin nephrotoxicity is a major concern, and other platinum compounds are being tried. We performed a monocentric retrospective analysis to evaluate the use of carboplatin, so-called DHAC+/-R regimen. The purpose was to assess the toxicity of the DHAC+/-R regimen in real-life. The Dexamethasone, Cytarabine, Carboplatin (DHAC) regimen consisted of carboplatin AUC = 5 mg/ml/min (targeted area under the curve with Calvert's formula) on day 1, cytarabine 2 g/m2twice a day on day 2 and IV dexamethasone 40 mg from days 1 to 4. Rituximab was administrated at 375 mg/m2on day 1 for CD20+ NHL. The interval between courses was 21 days. During the period considered, 199 patients received DHAC+/-R. For the entire cohort, median follow-up is 24 months (range, 2-82), median OS is not reached (NR), estimated 2-year OS is 75% (95% CI, 69-83) and median progression-free survival (PFS) is 46 months (95% CI, 22-NA). Of 144 patients scheduled for autologous stem cell transplantation (ASCT), 102 (71%, NA = 2) were in response after DHAC+/-R and all except 4 underwent ASCT. Grade ≥ 3 haematological toxicities were mainly thrombocytopenia (n = 101) and anaemia (n = 95). Grade ≥ 3 neutropenia occurred in 10 patients. No grade ≥ 3 renal and one grade 3 neurological toxicity were reported. DHAC+/-R is feasible in daily practice, provides good response rates and jeopardises neither stem cell collection nor ASCT.
authors.affiliation: Service d'hématologie clinique, CHU de Nantes, place Alexis Ricordeau, 44000, Nantes, France.|INSERM, UMR892, Equipe 10, Nantes, France.
authors.forename: B
authors.initials: B
authors.lastname: Tessoulin
authors.affiliation: Pharmacy Clinical Oncology Unit (UPCO), Department of Pharmacy, University Hospital of Nantes, Nantes, France.
authors.forename: P
authors.initials: P
authors.lastname: Thomare
authors.affiliation: Pharmacy Clinical Oncology Unit (UPCO), Department of Pharmacy, University Hospital of Nantes, Nantes, France.
authors.forename: E
authors.initials: E
authors.lastname: Delande
authors.affiliation: Pharmacy Clinical Oncology Unit (UPCO), Department of Pharmacy, University Hospital of Nantes, Nantes, France.
authors.forename: J
authors.initials: J
authors.lastname: Moynard
authors.affiliation: Service d'hématologie clinique, CHU de Nantes, place Alexis Ricordeau, 44000, Nantes, France.
authors.forename: T
authors.initials: T
authors.lastname: Gastinne
authors.affiliation: Department of Pathology, University Hospital of Nantes, Nantes, France.
authors.forename: A
authors.initials: A
authors.lastname: Moreau
authors.affiliation: Department of Pathology, University Hospital of Nantes, Nantes, France.
authors.forename: C
authors.initials: C
authors.lastname: Bossard
authors.affiliation: Service d'hématologie clinique, CHU de Nantes, place Alexis Ricordeau, 44000, Nantes, France.
authors.forename: B
authors.initials: B
authors.lastname: Mahé
authors.affiliation: Service d'hématologie clinique, CHU de Nantes, place Alexis Ricordeau, 44000, Nantes, France.
authors.forename: N
authors.initials: N
authors.lastname: Blin
authors.affiliation: Service d'hématologie clinique, CHU de Nantes, place Alexis Ricordeau, 44000, Nantes, France.
authors.forename: V
authors.initials: V
authors.lastname: Dubruille
authors.affiliation: Service d'hématologie clinique, CHU de Nantes, place Alexis Ricordeau, 44000, Nantes, France.
authors.forename: C
authors.initials: C
authors.lastname: Touzeau
authors.affiliation: Service d'hématologie clinique, CHU de Nantes, place Alexis Ricordeau, 44000, Nantes, France.
authors.forename: J S
authors.initials: JS
authors.lastname: Boudreault
authors.affiliation: Service d'hématologie clinique, CHU de Nantes, place Alexis Ricordeau, 44000, Nantes, France.
authors.forename: F
authors.initials: F
authors.lastname: Perrin
authors.affiliation: Service d'hématologie clinique, CHU de Nantes, place Alexis Ricordeau, 44000, Nantes, France.
authors.forename: A
authors.initials: A
authors.lastname: Lok
authors.affiliation: Service d'hématologie clinique, CHU de Nantes, place Alexis Ricordeau, 44000, Nantes, France.
authors.forename: T
authors.initials: T
authors.lastname: Guillaume
authors.affiliation: Service d'hématologie clinique, CHU de Nantes, place Alexis Ricordeau, 44000, Nantes, France.
authors.forename: A
authors.initials: A
authors.lastname: Garnier
authors.affiliation: Service d'hématologie clinique, CHU de Nantes, place Alexis Ricordeau, 44000, Nantes, France.
authors.forename: P
authors.initials: P
authors.lastname: Peterlin
authors.affiliation: Service d'hématologie clinique, CHU de Nantes, place Alexis Ricordeau, 44000, Nantes, France.
authors.forename: P
authors.initials: P
authors.lastname: Gallas
authors.affiliation: Service d'hématologie clinique, CHU de Nantes, place Alexis Ricordeau, 44000, Nantes, France.
authors.forename: P
authors.initials: P
authors.lastname: Chevallier
authors.affiliation: Service d'hématologie clinique, CHU de Nantes, place Alexis Ricordeau, 44000, Nantes, France.
authors.forename: P
authors.initials: P
authors.lastname: Moreau
authors.affiliation: Service d'hématologie clinique, CHU de Nantes, place Alexis Ricordeau, 44000, Nantes, France. steven.legouill@chu-nantes.fr.|INSERM, UMR892, Equipe 10, Nantes, France. steven.legouill@chu-nantes.fr.|INSERM, CIC 004, Nantes University Hospital, Nantes, France. steven.legouill@chu-nantes.fr.
authors.forename: Steven
authors.initials: S
authors.lastname: Le Gouill
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000740:Anemia / Q000139:chemically induced; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D003561:Cytarabine / Q000008:administration & dosage; D003907:Dexamethasone / Q000008:administration & dosage; D018572:Disease-Free Survival; D006689:Hodgkin Disease / Q000188:drug therapy* / Q000628:therapy; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy* / Q000628:therapy; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced; D012074:Remission Induction; D012189:Retrospective Studies; D000069283:Rituximab / Q000008:administration & dosage; D033581:Stem Cell Transplantation / Q000379:methods; D013921:Thrombocytopenia / Q000139:chemically induced; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D003561:Cytarabine; D000069283:Rituximab; D003907:Dexamethasone; D016190:Carboplatin; D002945:Cisplatin
keywords: Carboplatin; Cytarabine; DHAC; Lymphoma