ESHAP as salvage therapy for relapsed or refractory Hodgkin’s lymphoma

• Published in: Annals of hematology Vol. 93; no. 10; pp. 1745 - 1753
• Main Authors: Labrador, Jorge, Cabrero-Calvo, Mónica, Pérez-López, Estefanía, Mateos, María Victoria, Vázquez, Lourdes, Caballero, María Dolores, García-Sanz, Ramón
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-10-2014; Springer Nature B.V
• Subjects: Adolescent; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Carmustine - administration & dosage; Child; Cisplatin - administration & dosage; Cisplatin - adverse effects; Combined Modality Therapy; Cytarabine - administration & dosage; Cytarabine - adverse effects; Drug Evaluation; Etoposide - administration & dosage; Etoposide - adverse effects; Febrile Neutropenia - etiology; Female; Follow-Up Studies; Hematology; Hematopoietic Stem Cell Mobilization; Hodgkin Disease - diagnostic imaging; Hodgkin Disease - drug therapy; Hodgkin Disease - radiotherapy; Hodgkin Disease - therapy; Humans; Kaplan-Meier Estimate; Male; Medicine; Medicine & Public Health; Melphalan - administration & dosage; Methylprednisolone - administration & dosage; Methylprednisolone - adverse effects; Middle Aged; Oncology; Original Article; Radionuclide Imaging; Retrospective Studies; Salvage Therapy; Stem Cell Transplantation; Transplantation, Autologous; Treatment Outcome; Young Adult; Refractory; Autologous stem cell transplant; Relapse; ESHAP; Salvage therapy; Hodgkin’s lymphoma
• ISSN: 0939-5555; 1432-0584
• DOI: 10.1007/s00277-014-2114-0

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.