Prognostic relevance of DHAP dose-density in relapsed Hodgkin lymphoma: an analysis of the German Hodgkin-Study Group

• Authors: SASSE Stephanie; ALRAM Magdalena; MÜLLER Horst; ŠMARDOVÁ Lenka; METZNER Bernd; DOEHNER Hartmut; FISCHER Thomas; NIEDERWIESER Dietger W.; SCHMITZ Norbert; SCHÄFER-ECKART Kerstin; RAEMAEKERS John M. M.; SCHMALZ Oliver; TRESCKOW Bastian V.; ENGERT Andreas; BORCHMANN Peter
• Year of publication: 2016
• Type: Article in Periodical
• Magazine / Source: Leukemia & Lymphoma
• MU Faculty or unit: Faculty of Medicine
• Doi: http://dx.doi.org/10.3109/10428194.2015.1083561
• Field: Oncology and hematology
• Keywords: DHAP; dose density; hematotoxicity; outcome; relapsed Hodgkin lymphoma
• Description: Only 50% of patients with relapsed Hodgkin lymphoma (HL) can be cured with intensive induction chemotherapy, followed by high-dose chemotherapy (HDCT) and autologous stem cell transplant (ASCT). Based on the results of the HDR2 trial two courses of DHAP and subsequent HDCT/ASCT are the current standard of care in relapsed HL. In order to assess the prognostic relevance of DHAP dose density, we performed a retrospective multivariate analysis of the HDR2 trial (N=266). In addition to four risk factors (early or multiple relapse, stage IV disease or anemia at relapse, and grade IV hematotoxicity during the first cycle of DHAP) a delayed start of the second cycle of DHAP>day 22 predicted a significantly poorer progression-free survival (PFS, p=0.0356) and overall survival (OS, p=0.0025). In conclusion, our analysis strongly suggests that dose density of DHAP has a relevant impact on the outcome of relapsed HL patients.