Response to short course eshap chemotherapy in relapsed and refractory lymphoma
Robinson SP., Addada J., Green N., Wong WL., Shaw P., Chakraverty R., Goldstone AH., Macmillan A., Linch DC.
High dose therapy and peripheral blood stem cell transplantation is frequently used in patients with Hodgkins disease (HD) and non-Hodgkins lymphoma (NHL) who have failed to achieve or maintain a complete remission (CR) with conventional dose chemotherapy. In most cases one or two cycles of a standard dose salvage regimen is used prior to high dose therapy for the purposes of reducing tumour bulk and mobilising stem cells. We have previously shown that ESHAP is an excellent mobilisation regimen and studies from the M.D. Anderson have demonstrated its efficacy as an NHL salvage therapy. There is little data on the value of ESHAP in Hodgkins disease or in NHL where only one 1 or 2 cycles are administered. We have therefore analysed the responses in 119 lymphoma patients who had received an average of 1.6 cycles of ESHAP using the International Workshop Response Criteria. There were 34 patients with HD, 67 with high grade NHL (HGNHL) and 18 with low grade NHL (LGNHL) with median ages of 33.5, 52 and 51.5 years respectively. The ESHAP protocol consisted of etoposide 40mg/m2 days 1-4, cisplatin 25mg/m2 days 1-4, cytarabine 2g/m2 and methylprednisolone 500mg/m2 days 1-5. Patient status at initiation of ESHAP chemotherapy and response to treatment are shown below. HD High Grade NHL Low Grade NHL Status at ESHAP Refractory (%) 0 30 6 PR(%) 12 19 44 1st Relapse (%) 53 42 44 2nd Relapse (%) 24 6 0 3rd Relapse (%) 12 3 6 Response to ESHAP PR of Better (%) 32.4 30.6 50.1 Stable (%) 38.2 44.1 25 Progression (%) 23.5 23.7 25 Stem cell mobilisation was successful (greater than 2×106 CD34+ cells/kg) in 70 of 75 attempted cases. Only the pre-treatment variable of disease status (PR/1 st relapse/2nd relapse vs refractory diseaseβrd relapse) was predictive of progressive disease with to ESHAP (21.1 % vs 39.1 %, p<0.05). We conclude that ESHAP is equally efficacious in HD and both HGNHL and LGNHL. Only one third of patients have a PR or better with 1 -2 cycles of this regimen and approximately 25% have progressive disease.