DICEP IS AN EFFECTIVE CHEMOTHERAPEUTIC REGIMEN FOR PATIENTS WITH RELAPSED OR REFRACTORY LYMPHOMAS WHO FAILED PRIOR SALVAGE CHEMOTHERAPIES.
(Abstract release date: 05/19/16)
EHA Library. Almomen A. 06/09/16; 134620; PB1720
Abdulkareem Almomen
Contributions
Contributions
Abstract
Abstract: PB1720
Type: Publication Only
Background
The outcome of patients (pts) with relapsed or refractory Hodgkin’s (HL) and Non Hodgkin lymphomas (NHL) post failure of response to 1st salvage treatment tends to be very poor even after autologous stem cell transplantation (ASCT). Though several 2nd line salvage regimens have been used, the optimal treatment still remains an issue of clinical investigation and there is an unmet need for salvage chemotherapies, sufficiently strong to reduce the tumor burden with acceptable toxicities to allow safe yet successful ASCT.
Aims
We herein evaluated the DICEP regimen [Dose Intesified Cyclophoshamide (1,750 gr/m2), Etoposide (350 mg/m2) and Cisplatin (35 mg/m2), days 1-3] in terms of safety and efficacy regarding disease response and stem cell mobilization and collection.
Methods
We retrospectively analyzed the data of 21 (10 HL, 11 NHL) pts with a median age of 26 (16-60) yrs who had refractory or relapsed disease after ABVD or R-CHOP regimens ( 6-8 cycles) and received as 1st line salvage chemotherapy at least 2 cycles of ESHAP (13 pts), ICE (3 pts), ESHAP+ICE (2 pts) and other regimens (3 pts). Two out of 21 achieved complete remission (CR) post 1st salvage, 17 partial remission (>50% response, PR) while 2 had stable or progressive disease. A single cycle of DICEP was administered either as mobilization chemotherapy (in 2 pts with CR), or as 2nd salvage treatment for patients with PR, stable or progressive disease.
Results
DICEP was well tolerated and no lethal or major organ toxicities were observed. Nevertheless, all patients experienced hematological toxicity (gr 3-4 WHO) and 18/21 developed febrlile neutropenia (3/18 experienced septicemia), however that completely resolved with the appropriate antibiotic therapy not requiring admission to intensive care unit. The hospitalization period was 20 (11-25) days. All patients were successfully mobilized and a medium of 7,9 (2,8 -33,5)x106/kg CD34+ cells were collected after a median of 1 (1-3) days of apheresis procedure.Post DICEP administration, a further overall disease improvement of 42 % was observed (6 additional CRs and 2 PRs), whilst in 1 pt the disease proved to be refractory.Finally 20/21 pts underwent ASCT. The 3,5yrs overall survival (OS) and progression free survival (PFS) from DICEP administration were 50% for the whole cohort of patients. Specifically, for HD pts the 2 yrs OS and PFS were estimated to be 75% and 65% respectively, while for NHL the 3,5 yrs OS and PFS were 45% and 50% respectively.
Conclusion
Taking into account the limitations of the retrospective nature of the present study, it seems that DICEP regimen is a sufficient salvage treatment demonstrating acceptable toxicity without negatively affecting the collection process. The promising overall response rates post DICEP in combination with the encouraging OS and PFS rates achieved post ASCT in that heavily pretreated group of patients, strongly support the rationale to use DICEP regimen not only as a “bridge” to a successful ASCT but also as 1st line salvage regimen in selected pts.
Session topic: E-poster
Keyword(s): Autologous hematopoietic stem cell transplantation, Hodgkin's lymphoma, Non-Hodgkin's lymphoma, Salvage chemotherapy
Type: Publication Only
Background
The outcome of patients (pts) with relapsed or refractory Hodgkin’s (HL) and Non Hodgkin lymphomas (NHL) post failure of response to 1st salvage treatment tends to be very poor even after autologous stem cell transplantation (ASCT). Though several 2nd line salvage regimens have been used, the optimal treatment still remains an issue of clinical investigation and there is an unmet need for salvage chemotherapies, sufficiently strong to reduce the tumor burden with acceptable toxicities to allow safe yet successful ASCT.
Aims
We herein evaluated the DICEP regimen [Dose Intesified Cyclophoshamide (1,750 gr/m2), Etoposide (350 mg/m2) and Cisplatin (35 mg/m2), days 1-3] in terms of safety and efficacy regarding disease response and stem cell mobilization and collection.
Methods
We retrospectively analyzed the data of 21 (10 HL, 11 NHL) pts with a median age of 26 (16-60) yrs who had refractory or relapsed disease after ABVD or R-CHOP regimens ( 6-8 cycles) and received as 1st line salvage chemotherapy at least 2 cycles of ESHAP (13 pts), ICE (3 pts), ESHAP+ICE (2 pts) and other regimens (3 pts). Two out of 21 achieved complete remission (CR) post 1st salvage, 17 partial remission (>50% response, PR) while 2 had stable or progressive disease. A single cycle of DICEP was administered either as mobilization chemotherapy (in 2 pts with CR), or as 2nd salvage treatment for patients with PR, stable or progressive disease.
Results
DICEP was well tolerated and no lethal or major organ toxicities were observed. Nevertheless, all patients experienced hematological toxicity (gr 3-4 WHO) and 18/21 developed febrlile neutropenia (3/18 experienced septicemia), however that completely resolved with the appropriate antibiotic therapy not requiring admission to intensive care unit. The hospitalization period was 20 (11-25) days. All patients were successfully mobilized and a medium of 7,9 (2,8 -33,5)x106/kg CD34+ cells were collected after a median of 1 (1-3) days of apheresis procedure.Post DICEP administration, a further overall disease improvement of 42 % was observed (6 additional CRs and 2 PRs), whilst in 1 pt the disease proved to be refractory.Finally 20/21 pts underwent ASCT. The 3,5yrs overall survival (OS) and progression free survival (PFS) from DICEP administration were 50% for the whole cohort of patients. Specifically, for HD pts the 2 yrs OS and PFS were estimated to be 75% and 65% respectively, while for NHL the 3,5 yrs OS and PFS were 45% and 50% respectively.
Conclusion
Taking into account the limitations of the retrospective nature of the present study, it seems that DICEP regimen is a sufficient salvage treatment demonstrating acceptable toxicity without negatively affecting the collection process. The promising overall response rates post DICEP in combination with the encouraging OS and PFS rates achieved post ASCT in that heavily pretreated group of patients, strongly support the rationale to use DICEP regimen not only as a “bridge” to a successful ASCT but also as 1st line salvage regimen in selected pts.
Session topic: E-poster
Keyword(s): Autologous hematopoietic stem cell transplantation, Hodgkin's lymphoma, Non-Hodgkin's lymphoma, Salvage chemotherapy
Abstract: PB1720
Type: Publication Only
Background
The outcome of patients (pts) with relapsed or refractory Hodgkin’s (HL) and Non Hodgkin lymphomas (NHL) post failure of response to 1st salvage treatment tends to be very poor even after autologous stem cell transplantation (ASCT). Though several 2nd line salvage regimens have been used, the optimal treatment still remains an issue of clinical investigation and there is an unmet need for salvage chemotherapies, sufficiently strong to reduce the tumor burden with acceptable toxicities to allow safe yet successful ASCT.
Aims
We herein evaluated the DICEP regimen [Dose Intesified Cyclophoshamide (1,750 gr/m2), Etoposide (350 mg/m2) and Cisplatin (35 mg/m2), days 1-3] in terms of safety and efficacy regarding disease response and stem cell mobilization and collection.
Methods
We retrospectively analyzed the data of 21 (10 HL, 11 NHL) pts with a median age of 26 (16-60) yrs who had refractory or relapsed disease after ABVD or R-CHOP regimens ( 6-8 cycles) and received as 1st line salvage chemotherapy at least 2 cycles of ESHAP (13 pts), ICE (3 pts), ESHAP+ICE (2 pts) and other regimens (3 pts). Two out of 21 achieved complete remission (CR) post 1st salvage, 17 partial remission (>50% response, PR) while 2 had stable or progressive disease. A single cycle of DICEP was administered either as mobilization chemotherapy (in 2 pts with CR), or as 2nd salvage treatment for patients with PR, stable or progressive disease.
Results
DICEP was well tolerated and no lethal or major organ toxicities were observed. Nevertheless, all patients experienced hematological toxicity (gr 3-4 WHO) and 18/21 developed febrlile neutropenia (3/18 experienced septicemia), however that completely resolved with the appropriate antibiotic therapy not requiring admission to intensive care unit. The hospitalization period was 20 (11-25) days. All patients were successfully mobilized and a medium of 7,9 (2,8 -33,5)x106/kg CD34+ cells were collected after a median of 1 (1-3) days of apheresis procedure.Post DICEP administration, a further overall disease improvement of 42 % was observed (6 additional CRs and 2 PRs), whilst in 1 pt the disease proved to be refractory.Finally 20/21 pts underwent ASCT. The 3,5yrs overall survival (OS) and progression free survival (PFS) from DICEP administration were 50% for the whole cohort of patients. Specifically, for HD pts the 2 yrs OS and PFS were estimated to be 75% and 65% respectively, while for NHL the 3,5 yrs OS and PFS were 45% and 50% respectively.
Conclusion
Taking into account the limitations of the retrospective nature of the present study, it seems that DICEP regimen is a sufficient salvage treatment demonstrating acceptable toxicity without negatively affecting the collection process. The promising overall response rates post DICEP in combination with the encouraging OS and PFS rates achieved post ASCT in that heavily pretreated group of patients, strongly support the rationale to use DICEP regimen not only as a “bridge” to a successful ASCT but also as 1st line salvage regimen in selected pts.
Session topic: E-poster
Keyword(s): Autologous hematopoietic stem cell transplantation, Hodgkin's lymphoma, Non-Hodgkin's lymphoma, Salvage chemotherapy
Type: Publication Only
Background
The outcome of patients (pts) with relapsed or refractory Hodgkin’s (HL) and Non Hodgkin lymphomas (NHL) post failure of response to 1st salvage treatment tends to be very poor even after autologous stem cell transplantation (ASCT). Though several 2nd line salvage regimens have been used, the optimal treatment still remains an issue of clinical investigation and there is an unmet need for salvage chemotherapies, sufficiently strong to reduce the tumor burden with acceptable toxicities to allow safe yet successful ASCT.
Aims
We herein evaluated the DICEP regimen [Dose Intesified Cyclophoshamide (1,750 gr/m2), Etoposide (350 mg/m2) and Cisplatin (35 mg/m2), days 1-3] in terms of safety and efficacy regarding disease response and stem cell mobilization and collection.
Methods
We retrospectively analyzed the data of 21 (10 HL, 11 NHL) pts with a median age of 26 (16-60) yrs who had refractory or relapsed disease after ABVD or R-CHOP regimens ( 6-8 cycles) and received as 1st line salvage chemotherapy at least 2 cycles of ESHAP (13 pts), ICE (3 pts), ESHAP+ICE (2 pts) and other regimens (3 pts). Two out of 21 achieved complete remission (CR) post 1st salvage, 17 partial remission (>50% response, PR) while 2 had stable or progressive disease. A single cycle of DICEP was administered either as mobilization chemotherapy (in 2 pts with CR), or as 2nd salvage treatment for patients with PR, stable or progressive disease.
Results
DICEP was well tolerated and no lethal or major organ toxicities were observed. Nevertheless, all patients experienced hematological toxicity (gr 3-4 WHO) and 18/21 developed febrlile neutropenia (3/18 experienced septicemia), however that completely resolved with the appropriate antibiotic therapy not requiring admission to intensive care unit. The hospitalization period was 20 (11-25) days. All patients were successfully mobilized and a medium of 7,9 (2,8 -33,5)x106/kg CD34+ cells were collected after a median of 1 (1-3) days of apheresis procedure.Post DICEP administration, a further overall disease improvement of 42 % was observed (6 additional CRs and 2 PRs), whilst in 1 pt the disease proved to be refractory.Finally 20/21 pts underwent ASCT. The 3,5yrs overall survival (OS) and progression free survival (PFS) from DICEP administration were 50% for the whole cohort of patients. Specifically, for HD pts the 2 yrs OS and PFS were estimated to be 75% and 65% respectively, while for NHL the 3,5 yrs OS and PFS were 45% and 50% respectively.
Conclusion
Taking into account the limitations of the retrospective nature of the present study, it seems that DICEP regimen is a sufficient salvage treatment demonstrating acceptable toxicity without negatively affecting the collection process. The promising overall response rates post DICEP in combination with the encouraging OS and PFS rates achieved post ASCT in that heavily pretreated group of patients, strongly support the rationale to use DICEP regimen not only as a “bridge” to a successful ASCT but also as 1st line salvage regimen in selected pts.
Session topic: E-poster
Keyword(s): Autologous hematopoietic stem cell transplantation, Hodgkin's lymphoma, Non-Hodgkin's lymphoma, Salvage chemotherapy
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