EFFICACY OF ESHAP REGIMEN IN THE ABSENCE OF AUTOLOGOUS STEM CELL TRANSPLANTATION IN RELAPSED/REFRACTORY T-CELL LYMPHOMA
(Abstract release date: 05/19/16)
EHA Library. Norasetthada L. 06/09/16; 134611; PB1711
Dr. Lalita Norasetthada
Contributions
Contributions
Abstract
Abstract: PB1711
Type: Publication Only
Background
After relapse, prognosis of patients with peripheral T-cell lymphoma (PTCLs) was poor. Currently, there was no standard salvage regimen for PTCLs. ESHAP regimen, consisting of etoposide, methylprednisolone, high-dose Ara-C, and cisplatin, is one of the well accepted regimens for relapsed or refractory (R/R) lymphoma. However, the efficacy of ESHAP have been examined in the cohorts of various subtypes of R/R NHL, not specifically described the outcome in those with PTCLs.
Aims
The purpose of this study was to determine the efficacy and safety of ESHAP as first salvage regimen, not followed by stem cell transplantation (SCT), in R/R PTCLs.
Methods
According to institute's treatment plan, ESHAP was recommended as first salvage regimen for R/R PTCLs. We retrospectively evaluated the efficiency and safety of ESHAP in patients with PTCLs who progressed after one prior therapy and did not undergo salvage SCT. Disease status at first relapse/progression was categorized as early relapse (relapsed within 12 months after the completion of frontline therapy), late relapse (relapsed after 12 months of frontline treatment) and refractory disease (achieving less than partial response after frontline chemotherapy).
Results
From 2004 to 2014, 33 patients with R/R PTCLs received ESHAP as first salvage regimen at Chiang Mai University hospital. Overall response rate was 46% with complete responses (CR) of 39%. Median duration of response was 18 months with the longest duration of 131 months. Patients with PTCL-NOS, the most common subtype treated in this cohort (n=18), had ORR of 50% (CR/CRu 44%). None of the patients with HSTL and EATL type II responded to ESHAP. Reponses were independently influenced by disease status at first relapse/progression (Odd ratio; OR 2.7, 95%CI: 1.46-5.15) and secondary IPI (OR 2.12, 95%CI: 1.06-4.29). Median second progression-free (PFS) and overall survival (OS) were 8.0 and 11.0 months, respectively. Patients having late relapsed disease after frontline treatment had more favorable OS than those having early relapsed or refractory disease with a median OS of 21, 17 and 3 months, respectively (P=.001). The corresponding figures for median second PFS were 16, 8 and 2 months, respectively (P=.001). Patients achieving CR after ESHAP had significantly better median OS (39, 7 and 5 months, P<.0001) and second PFS (33, 2 and 2 months, P<.0001) than those achieving PR or having progressive disease. By multivariate analysis, the only factor affected OS was the response to ESHAP (HR 4.7, 95%CI 2.2-10.0, P<.0001) while second PFS was affected by the response to ESHAP (HR 5.9, 95%CI 2.4-14.6, P<.0001) and disease status at relapse/progression (HR 3.4, 95%CI1.2-9.7, P-value=.025). Grade 3-4 neutropenia (45.5%) and thrombocytopenia (33.4%) were common but manageable. Grade I-II transient rising of serum creatinine was observed in 36.4% of patients.
Conclusion
ESHAP has acceptable efficacy and toxicity for R/R PTCLs. It offers a long-term survival in patients with chemosensitive relapse who are not suitable for SCT.
Session topic: E-poster
Keyword(s): Peripheral T-cell lymphoma, Relapsed lymphoma
Type: Publication Only
Background
After relapse, prognosis of patients with peripheral T-cell lymphoma (PTCLs) was poor. Currently, there was no standard salvage regimen for PTCLs. ESHAP regimen, consisting of etoposide, methylprednisolone, high-dose Ara-C, and cisplatin, is one of the well accepted regimens for relapsed or refractory (R/R) lymphoma. However, the efficacy of ESHAP have been examined in the cohorts of various subtypes of R/R NHL, not specifically described the outcome in those with PTCLs.
Aims
The purpose of this study was to determine the efficacy and safety of ESHAP as first salvage regimen, not followed by stem cell transplantation (SCT), in R/R PTCLs.
Methods
According to institute's treatment plan, ESHAP was recommended as first salvage regimen for R/R PTCLs. We retrospectively evaluated the efficiency and safety of ESHAP in patients with PTCLs who progressed after one prior therapy and did not undergo salvage SCT. Disease status at first relapse/progression was categorized as early relapse (relapsed within 12 months after the completion of frontline therapy), late relapse (relapsed after 12 months of frontline treatment) and refractory disease (achieving less than partial response after frontline chemotherapy).
Results
From 2004 to 2014, 33 patients with R/R PTCLs received ESHAP as first salvage regimen at Chiang Mai University hospital. Overall response rate was 46% with complete responses (CR) of 39%. Median duration of response was 18 months with the longest duration of 131 months. Patients with PTCL-NOS, the most common subtype treated in this cohort (n=18), had ORR of 50% (CR/CRu 44%). None of the patients with HSTL and EATL type II responded to ESHAP. Reponses were independently influenced by disease status at first relapse/progression (Odd ratio; OR 2.7, 95%CI: 1.46-5.15) and secondary IPI (OR 2.12, 95%CI: 1.06-4.29). Median second progression-free (PFS) and overall survival (OS) were 8.0 and 11.0 months, respectively. Patients having late relapsed disease after frontline treatment had more favorable OS than those having early relapsed or refractory disease with a median OS of 21, 17 and 3 months, respectively (P=.001). The corresponding figures for median second PFS were 16, 8 and 2 months, respectively (P=.001). Patients achieving CR after ESHAP had significantly better median OS (39, 7 and 5 months, P<.0001) and second PFS (33, 2 and 2 months, P<.0001) than those achieving PR or having progressive disease. By multivariate analysis, the only factor affected OS was the response to ESHAP (HR 4.7, 95%CI 2.2-10.0, P<.0001) while second PFS was affected by the response to ESHAP (HR 5.9, 95%CI 2.4-14.6, P<.0001) and disease status at relapse/progression (HR 3.4, 95%CI1.2-9.7, P-value=.025). Grade 3-4 neutropenia (45.5%) and thrombocytopenia (33.4%) were common but manageable. Grade I-II transient rising of serum creatinine was observed in 36.4% of patients.
Conclusion
ESHAP has acceptable efficacy and toxicity for R/R PTCLs. It offers a long-term survival in patients with chemosensitive relapse who are not suitable for SCT.
Session topic: E-poster
Keyword(s): Peripheral T-cell lymphoma, Relapsed lymphoma
Abstract: PB1711
Type: Publication Only
Background
After relapse, prognosis of patients with peripheral T-cell lymphoma (PTCLs) was poor. Currently, there was no standard salvage regimen for PTCLs. ESHAP regimen, consisting of etoposide, methylprednisolone, high-dose Ara-C, and cisplatin, is one of the well accepted regimens for relapsed or refractory (R/R) lymphoma. However, the efficacy of ESHAP have been examined in the cohorts of various subtypes of R/R NHL, not specifically described the outcome in those with PTCLs.
Aims
The purpose of this study was to determine the efficacy and safety of ESHAP as first salvage regimen, not followed by stem cell transplantation (SCT), in R/R PTCLs.
Methods
According to institute's treatment plan, ESHAP was recommended as first salvage regimen for R/R PTCLs. We retrospectively evaluated the efficiency and safety of ESHAP in patients with PTCLs who progressed after one prior therapy and did not undergo salvage SCT. Disease status at first relapse/progression was categorized as early relapse (relapsed within 12 months after the completion of frontline therapy), late relapse (relapsed after 12 months of frontline treatment) and refractory disease (achieving less than partial response after frontline chemotherapy).
Results
From 2004 to 2014, 33 patients with R/R PTCLs received ESHAP as first salvage regimen at Chiang Mai University hospital. Overall response rate was 46% with complete responses (CR) of 39%. Median duration of response was 18 months with the longest duration of 131 months. Patients with PTCL-NOS, the most common subtype treated in this cohort (n=18), had ORR of 50% (CR/CRu 44%). None of the patients with HSTL and EATL type II responded to ESHAP. Reponses were independently influenced by disease status at first relapse/progression (Odd ratio; OR 2.7, 95%CI: 1.46-5.15) and secondary IPI (OR 2.12, 95%CI: 1.06-4.29). Median second progression-free (PFS) and overall survival (OS) were 8.0 and 11.0 months, respectively. Patients having late relapsed disease after frontline treatment had more favorable OS than those having early relapsed or refractory disease with a median OS of 21, 17 and 3 months, respectively (P=.001). The corresponding figures for median second PFS were 16, 8 and 2 months, respectively (P=.001). Patients achieving CR after ESHAP had significantly better median OS (39, 7 and 5 months, P<.0001) and second PFS (33, 2 and 2 months, P<.0001) than those achieving PR or having progressive disease. By multivariate analysis, the only factor affected OS was the response to ESHAP (HR 4.7, 95%CI 2.2-10.0, P<.0001) while second PFS was affected by the response to ESHAP (HR 5.9, 95%CI 2.4-14.6, P<.0001) and disease status at relapse/progression (HR 3.4, 95%CI1.2-9.7, P-value=.025). Grade 3-4 neutropenia (45.5%) and thrombocytopenia (33.4%) were common but manageable. Grade I-II transient rising of serum creatinine was observed in 36.4% of patients.
Conclusion
ESHAP has acceptable efficacy and toxicity for R/R PTCLs. It offers a long-term survival in patients with chemosensitive relapse who are not suitable for SCT.
Session topic: E-poster
Keyword(s): Peripheral T-cell lymphoma, Relapsed lymphoma
Type: Publication Only
Background
After relapse, prognosis of patients with peripheral T-cell lymphoma (PTCLs) was poor. Currently, there was no standard salvage regimen for PTCLs. ESHAP regimen, consisting of etoposide, methylprednisolone, high-dose Ara-C, and cisplatin, is one of the well accepted regimens for relapsed or refractory (R/R) lymphoma. However, the efficacy of ESHAP have been examined in the cohorts of various subtypes of R/R NHL, not specifically described the outcome in those with PTCLs.
Aims
The purpose of this study was to determine the efficacy and safety of ESHAP as first salvage regimen, not followed by stem cell transplantation (SCT), in R/R PTCLs.
Methods
According to institute's treatment plan, ESHAP was recommended as first salvage regimen for R/R PTCLs. We retrospectively evaluated the efficiency and safety of ESHAP in patients with PTCLs who progressed after one prior therapy and did not undergo salvage SCT. Disease status at first relapse/progression was categorized as early relapse (relapsed within 12 months after the completion of frontline therapy), late relapse (relapsed after 12 months of frontline treatment) and refractory disease (achieving less than partial response after frontline chemotherapy).
Results
From 2004 to 2014, 33 patients with R/R PTCLs received ESHAP as first salvage regimen at Chiang Mai University hospital. Overall response rate was 46% with complete responses (CR) of 39%. Median duration of response was 18 months with the longest duration of 131 months. Patients with PTCL-NOS, the most common subtype treated in this cohort (n=18), had ORR of 50% (CR/CRu 44%). None of the patients with HSTL and EATL type II responded to ESHAP. Reponses were independently influenced by disease status at first relapse/progression (Odd ratio; OR 2.7, 95%CI: 1.46-5.15) and secondary IPI (OR 2.12, 95%CI: 1.06-4.29). Median second progression-free (PFS) and overall survival (OS) were 8.0 and 11.0 months, respectively. Patients having late relapsed disease after frontline treatment had more favorable OS than those having early relapsed or refractory disease with a median OS of 21, 17 and 3 months, respectively (P=.001). The corresponding figures for median second PFS were 16, 8 and 2 months, respectively (P=.001). Patients achieving CR after ESHAP had significantly better median OS (39, 7 and 5 months, P<.0001) and second PFS (33, 2 and 2 months, P<.0001) than those achieving PR or having progressive disease. By multivariate analysis, the only factor affected OS was the response to ESHAP (HR 4.7, 95%CI 2.2-10.0, P<.0001) while second PFS was affected by the response to ESHAP (HR 5.9, 95%CI 2.4-14.6, P<.0001) and disease status at relapse/progression (HR 3.4, 95%CI1.2-9.7, P-value=.025). Grade 3-4 neutropenia (45.5%) and thrombocytopenia (33.4%) were common but manageable. Grade I-II transient rising of serum creatinine was observed in 36.4% of patients.
Conclusion
ESHAP has acceptable efficacy and toxicity for R/R PTCLs. It offers a long-term survival in patients with chemosensitive relapse who are not suitable for SCT.
Session topic: E-poster
Keyword(s): Peripheral T-cell lymphoma, Relapsed lymphoma
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