Cisplatin-Based Protocols as Salvage Therapy for Relapsed or Refractory Hodgkin’s Lymphoma Patients.

We have analyzed the results in terms of response rate and peripheral blood progenitor cell (PBPC) mobilization ability of two cisplatin-based chemotherapy salvage regimens [DHAP (cisplatin 100 mg/m² iv day 1, ara-c 4 g/m² iv day 2 and dexamethasone 40 mg po days 1-4) and ESHAP (etoposide 40 mg/m² iv days 1–4, cisplatin 25 mg/m² iv days 1–4, ara-c 2 g/m² iv day 5 and methilprednisolone 500 mg iv days 1–5)] in a group of 110 patients with Hodgkin’s lymphoma (HL) in first or subsequent relapses. There were 70 males and 40 females with a median age at diagnosis of 29 years (range, 10 – 79). Sixty seven patients (64%) presented with advanced stage, 54% of them had B symptoms, 32% bulky mediastinal mass and 38%, extranodal disease. Disease status at the time of administration of the salvage protocol was primary refractory disease (PRD) (n = 16, 17%), first relapse (n = 65, 69%), second or subsequent relapse (n = 10, 11%) and relapse after a prior autologous stem cell transplantation (ASCT) (n = 3, 3%). Twenty-seven patients (26%) received the DHAP protocol and the remaining 78 (74%), the ESHAP protocol. Median time from diagnosis to the salvage therapy was 15 (range, 1 – 249) mo. In patients treated after a first relapse, the median duration of the first complete remission (CR) was 7 (range, 1 – 77) mo, with 18% of the patients relapsing after a long first CR (> 12 mo). Median number of cycles administered per patient was 2 (range, 1 – 3) with a median time interval between cycles of 28 (range, 21 – 76) days. PBPCs were collected after the second and the third cycle of chemotherapy in 35% and 49% of the patients respectively and was successful (> 2.0 x 10⁶ CD34+ cells/kg) in 97% of them. Grade 3–4 hematological toxicity was seen in 20% of the cycles with severe neutropenia (< 0.5 x 10⁹/l granulocytes) and thrombocytopenia (< 20 x 10⁹/l platelets) developing in 26% and 7% of the cycles, respectively. The most frequent grade 3–4 extra-hematological toxicity was nausea/vomiting (30%). Procedure related mortality was 2%. Response rate (RR) was 78% [CR: 39%, partial remission (PR): 39%] with significant differences between patients treated for PRD [RR of 41% (CR: 12%, PR: 29%)] and those treated for disease relapse [RR of 86% (CR: 44%, PR: 42%)] (p = 0.005). Cisplatin-based regimens are a useful therapeutical strategy in the treatment of refractory or relapsed HL due to a high overall RR and an adequate PBPC mobilization ability. Results in terms of disease response are significantly worse in patients treated for PRD.