THE EFFECT OF THE DHAP REGIMEN ON STEM CELL MOBILIZATION AND TRANSPLANT OUTCOMES OF PATIENTS WITH NON-HODGKIN LYMPHOMA WHO ARE CANDIDATES FOR UP-FRONT AUTOLOGOUS STEM CELL TRANSPLANTATION
(Abstract release date: 05/19/16)
EHA Library. Kwak J. 06/09/16; 135058; PB2158
Dr. Jae-Yong Kwak
Contributions
Contributions
Abstract
Abstract: PB2158
Type: Publication Only
Background
Data on dexamethasone, cytarabine, and cisplatin (DHAP) as a mobilization regimen, compared to high-dose cyclophosphamide (HDC), for up-front autologous stem cell transplantation (ASCT) in non-Hodgkin lymphoma (NHL) are limited.
Aims
The aims of this study were to compare the efficacy of peripheral blood stem cell (PBSC) mobilization of DHAP regimen with HDC in combination with G-CSF in patients with aggressive NHL who were candidates for up-front ASCT, and to investigate the effect of DHAP mobilization on overall survival (OS).
Methods
We conducted a multicenter, retrospective cohort study on patients who were diagnosed with aggressive NHL and treated with CHOP or rituximab-CHOP and subsequent PBSC mobilization using HDC (4.0g/m2) or DHAP (cisplatin 100mg/m2 D1, cytarabine 4.0g/m2 D2, dexamethasone 40mg D1-4) plus G-CSF regimens for up-front ASCT in 3 Korean institutions between 2004 and 2014. Successful mobilization was defined as collected CD34+ cell count ≥5.0 × 106/kg, but mobilization failure was defined as collected CD34+ cells <2.0 × 106/kg.
Results
Ninety-six patients (57 male, 39 female) with a median age of 48 years (range, 18-66) were included. Thirty-one patients (32.3%) received DHAP regimen and 65 (67.7%) received HDC. Diffuse large B-cell lymphoma (DLBCL, 54.2%) was the most common histologic type, and remaining included peripheral T-cell lymphoma (PTCL), not otherwise specified (28.1%), anaplastic lymphoma kinase-negative anaplastic large cell lymphoma (12.5%) and angioimmunoblastic T-cell lymphoma (5.2%).The number of total CD34+ cells collected per patient was significantly higher in the DHAP group than the HDC group (median, 16.1 vs. 6.1 × 106/kg, P=0.001). More patients in the DHAP group achieved successful mobilization compared to the HDC group (87.1% vs. 61.5%; P=0.011), whereas the rate of mobilization failure was higher in the HDC group (33.8% vs. 3.2%; P=0.032). In multivariate analysis, no bone marrow involvement (odds ratio [OR], 4.60 [95% CI, 1.20-17.61]), no prior radiotherapy (OR, 11.78 [1.68-82.39]), WBC counts at first apheresis day >1,785/uL (OR, 9.25 [2.89-29.58]), and the DHAP regimen (OR, 4.12 [95% CI, 1.12-15.17]) were independent predictors for successful mobilization. Febrile neutropenia developed 3 patients (9.7%) in DHAP group, which was less frequent than HDC group (N=21 [32.3%], P=0.043).Of the 96 patients, 2 patients did not proceed to up-front ASCT (1 failed mobilization, 1 patient’s refusal). Following the reinfusion of PBSC, median time to neutrophil/platelet engrafts did not significantly different according to mobilization regimen. With a median follow-up of 57.4 months (range, 9.1-143.4), the 5-year OS rates were not significantly different between the DHAP and the HDC groups (74.0% vs. 72.2%; P=0.936). Because of the heterogeneous histologic types in the study, additional subgroup analyses were performed separately based on the histologic types, but the OS in patients with either DLBCL or PTCL was not different according to the mobilizing regimens (P>0.05).
Conclusion
Our study showed that the DHAP regimen was associated with higher efficacy for PBSC mobilization and less frequent episodes of febrile neutropenia compared to the HDC regimen. Although there was no clinically meaningful OS improvement in the DHAP group, the DHAP regimen reduced significant rates of mobilization failure. Therefore, DHAP plus G-CSF can be effective in patients with NHL undergoing up-front ASCT.
Session topic: E-poster
Keyword(s): Autologous hematopoietic stem cell transplantation, Mobilization, Non-Hodgkin's lymphoma
Type: Publication Only
Background
Data on dexamethasone, cytarabine, and cisplatin (DHAP) as a mobilization regimen, compared to high-dose cyclophosphamide (HDC), for up-front autologous stem cell transplantation (ASCT) in non-Hodgkin lymphoma (NHL) are limited.
Aims
The aims of this study were to compare the efficacy of peripheral blood stem cell (PBSC) mobilization of DHAP regimen with HDC in combination with G-CSF in patients with aggressive NHL who were candidates for up-front ASCT, and to investigate the effect of DHAP mobilization on overall survival (OS).
Methods
We conducted a multicenter, retrospective cohort study on patients who were diagnosed with aggressive NHL and treated with CHOP or rituximab-CHOP and subsequent PBSC mobilization using HDC (4.0g/m2) or DHAP (cisplatin 100mg/m2 D1, cytarabine 4.0g/m2 D2, dexamethasone 40mg D1-4) plus G-CSF regimens for up-front ASCT in 3 Korean institutions between 2004 and 2014. Successful mobilization was defined as collected CD34+ cell count ≥5.0 × 106/kg, but mobilization failure was defined as collected CD34+ cells <2.0 × 106/kg.
Results
Ninety-six patients (57 male, 39 female) with a median age of 48 years (range, 18-66) were included. Thirty-one patients (32.3%) received DHAP regimen and 65 (67.7%) received HDC. Diffuse large B-cell lymphoma (DLBCL, 54.2%) was the most common histologic type, and remaining included peripheral T-cell lymphoma (PTCL), not otherwise specified (28.1%), anaplastic lymphoma kinase-negative anaplastic large cell lymphoma (12.5%) and angioimmunoblastic T-cell lymphoma (5.2%).The number of total CD34+ cells collected per patient was significantly higher in the DHAP group than the HDC group (median, 16.1 vs. 6.1 × 106/kg, P=0.001). More patients in the DHAP group achieved successful mobilization compared to the HDC group (87.1% vs. 61.5%; P=0.011), whereas the rate of mobilization failure was higher in the HDC group (33.8% vs. 3.2%; P=0.032). In multivariate analysis, no bone marrow involvement (odds ratio [OR], 4.60 [95% CI, 1.20-17.61]), no prior radiotherapy (OR, 11.78 [1.68-82.39]), WBC counts at first apheresis day >1,785/uL (OR, 9.25 [2.89-29.58]), and the DHAP regimen (OR, 4.12 [95% CI, 1.12-15.17]) were independent predictors for successful mobilization. Febrile neutropenia developed 3 patients (9.7%) in DHAP group, which was less frequent than HDC group (N=21 [32.3%], P=0.043).Of the 96 patients, 2 patients did not proceed to up-front ASCT (1 failed mobilization, 1 patient’s refusal). Following the reinfusion of PBSC, median time to neutrophil/platelet engrafts did not significantly different according to mobilization regimen. With a median follow-up of 57.4 months (range, 9.1-143.4), the 5-year OS rates were not significantly different between the DHAP and the HDC groups (74.0% vs. 72.2%; P=0.936). Because of the heterogeneous histologic types in the study, additional subgroup analyses were performed separately based on the histologic types, but the OS in patients with either DLBCL or PTCL was not different according to the mobilizing regimens (P>0.05).
Conclusion
Our study showed that the DHAP regimen was associated with higher efficacy for PBSC mobilization and less frequent episodes of febrile neutropenia compared to the HDC regimen. Although there was no clinically meaningful OS improvement in the DHAP group, the DHAP regimen reduced significant rates of mobilization failure. Therefore, DHAP plus G-CSF can be effective in patients with NHL undergoing up-front ASCT.
Session topic: E-poster
Keyword(s): Autologous hematopoietic stem cell transplantation, Mobilization, Non-Hodgkin's lymphoma
Abstract: PB2158
Type: Publication Only
Background
Data on dexamethasone, cytarabine, and cisplatin (DHAP) as a mobilization regimen, compared to high-dose cyclophosphamide (HDC), for up-front autologous stem cell transplantation (ASCT) in non-Hodgkin lymphoma (NHL) are limited.
Aims
The aims of this study were to compare the efficacy of peripheral blood stem cell (PBSC) mobilization of DHAP regimen with HDC in combination with G-CSF in patients with aggressive NHL who were candidates for up-front ASCT, and to investigate the effect of DHAP mobilization on overall survival (OS).
Methods
We conducted a multicenter, retrospective cohort study on patients who were diagnosed with aggressive NHL and treated with CHOP or rituximab-CHOP and subsequent PBSC mobilization using HDC (4.0g/m2) or DHAP (cisplatin 100mg/m2 D1, cytarabine 4.0g/m2 D2, dexamethasone 40mg D1-4) plus G-CSF regimens for up-front ASCT in 3 Korean institutions between 2004 and 2014. Successful mobilization was defined as collected CD34+ cell count ≥5.0 × 106/kg, but mobilization failure was defined as collected CD34+ cells <2.0 × 106/kg.
Results
Ninety-six patients (57 male, 39 female) with a median age of 48 years (range, 18-66) were included. Thirty-one patients (32.3%) received DHAP regimen and 65 (67.7%) received HDC. Diffuse large B-cell lymphoma (DLBCL, 54.2%) was the most common histologic type, and remaining included peripheral T-cell lymphoma (PTCL), not otherwise specified (28.1%), anaplastic lymphoma kinase-negative anaplastic large cell lymphoma (12.5%) and angioimmunoblastic T-cell lymphoma (5.2%).The number of total CD34+ cells collected per patient was significantly higher in the DHAP group than the HDC group (median, 16.1 vs. 6.1 × 106/kg, P=0.001). More patients in the DHAP group achieved successful mobilization compared to the HDC group (87.1% vs. 61.5%; P=0.011), whereas the rate of mobilization failure was higher in the HDC group (33.8% vs. 3.2%; P=0.032). In multivariate analysis, no bone marrow involvement (odds ratio [OR], 4.60 [95% CI, 1.20-17.61]), no prior radiotherapy (OR, 11.78 [1.68-82.39]), WBC counts at first apheresis day >1,785/uL (OR, 9.25 [2.89-29.58]), and the DHAP regimen (OR, 4.12 [95% CI, 1.12-15.17]) were independent predictors for successful mobilization. Febrile neutropenia developed 3 patients (9.7%) in DHAP group, which was less frequent than HDC group (N=21 [32.3%], P=0.043).Of the 96 patients, 2 patients did not proceed to up-front ASCT (1 failed mobilization, 1 patient’s refusal). Following the reinfusion of PBSC, median time to neutrophil/platelet engrafts did not significantly different according to mobilization regimen. With a median follow-up of 57.4 months (range, 9.1-143.4), the 5-year OS rates were not significantly different between the DHAP and the HDC groups (74.0% vs. 72.2%; P=0.936). Because of the heterogeneous histologic types in the study, additional subgroup analyses were performed separately based on the histologic types, but the OS in patients with either DLBCL or PTCL was not different according to the mobilizing regimens (P>0.05).
Conclusion
Our study showed that the DHAP regimen was associated with higher efficacy for PBSC mobilization and less frequent episodes of febrile neutropenia compared to the HDC regimen. Although there was no clinically meaningful OS improvement in the DHAP group, the DHAP regimen reduced significant rates of mobilization failure. Therefore, DHAP plus G-CSF can be effective in patients with NHL undergoing up-front ASCT.
Session topic: E-poster
Keyword(s): Autologous hematopoietic stem cell transplantation, Mobilization, Non-Hodgkin's lymphoma
Type: Publication Only
Background
Data on dexamethasone, cytarabine, and cisplatin (DHAP) as a mobilization regimen, compared to high-dose cyclophosphamide (HDC), for up-front autologous stem cell transplantation (ASCT) in non-Hodgkin lymphoma (NHL) are limited.
Aims
The aims of this study were to compare the efficacy of peripheral blood stem cell (PBSC) mobilization of DHAP regimen with HDC in combination with G-CSF in patients with aggressive NHL who were candidates for up-front ASCT, and to investigate the effect of DHAP mobilization on overall survival (OS).
Methods
We conducted a multicenter, retrospective cohort study on patients who were diagnosed with aggressive NHL and treated with CHOP or rituximab-CHOP and subsequent PBSC mobilization using HDC (4.0g/m2) or DHAP (cisplatin 100mg/m2 D1, cytarabine 4.0g/m2 D2, dexamethasone 40mg D1-4) plus G-CSF regimens for up-front ASCT in 3 Korean institutions between 2004 and 2014. Successful mobilization was defined as collected CD34+ cell count ≥5.0 × 106/kg, but mobilization failure was defined as collected CD34+ cells <2.0 × 106/kg.
Results
Ninety-six patients (57 male, 39 female) with a median age of 48 years (range, 18-66) were included. Thirty-one patients (32.3%) received DHAP regimen and 65 (67.7%) received HDC. Diffuse large B-cell lymphoma (DLBCL, 54.2%) was the most common histologic type, and remaining included peripheral T-cell lymphoma (PTCL), not otherwise specified (28.1%), anaplastic lymphoma kinase-negative anaplastic large cell lymphoma (12.5%) and angioimmunoblastic T-cell lymphoma (5.2%).The number of total CD34+ cells collected per patient was significantly higher in the DHAP group than the HDC group (median, 16.1 vs. 6.1 × 106/kg, P=0.001). More patients in the DHAP group achieved successful mobilization compared to the HDC group (87.1% vs. 61.5%; P=0.011), whereas the rate of mobilization failure was higher in the HDC group (33.8% vs. 3.2%; P=0.032). In multivariate analysis, no bone marrow involvement (odds ratio [OR], 4.60 [95% CI, 1.20-17.61]), no prior radiotherapy (OR, 11.78 [1.68-82.39]), WBC counts at first apheresis day >1,785/uL (OR, 9.25 [2.89-29.58]), and the DHAP regimen (OR, 4.12 [95% CI, 1.12-15.17]) were independent predictors for successful mobilization. Febrile neutropenia developed 3 patients (9.7%) in DHAP group, which was less frequent than HDC group (N=21 [32.3%], P=0.043).Of the 96 patients, 2 patients did not proceed to up-front ASCT (1 failed mobilization, 1 patient’s refusal). Following the reinfusion of PBSC, median time to neutrophil/platelet engrafts did not significantly different according to mobilization regimen. With a median follow-up of 57.4 months (range, 9.1-143.4), the 5-year OS rates were not significantly different between the DHAP and the HDC groups (74.0% vs. 72.2%; P=0.936). Because of the heterogeneous histologic types in the study, additional subgroup analyses were performed separately based on the histologic types, but the OS in patients with either DLBCL or PTCL was not different according to the mobilizing regimens (P>0.05).
Conclusion
Our study showed that the DHAP regimen was associated with higher efficacy for PBSC mobilization and less frequent episodes of febrile neutropenia compared to the HDC regimen. Although there was no clinically meaningful OS improvement in the DHAP group, the DHAP regimen reduced significant rates of mobilization failure. Therefore, DHAP plus G-CSF can be effective in patients with NHL undergoing up-front ASCT.
Session topic: E-poster
Keyword(s): Autologous hematopoietic stem cell transplantation, Mobilization, Non-Hodgkin's lymphoma
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