The effect of the dexamethasone, cytarabine, and cisplatin (DHAP) regimen on stem cell mobilization and transplant outcomes of patients with non-Hodgkin's lymphoma who are candidates for up-front autologous stem cell transplantation.
- Author:
So Yeon JEON
1
;
Ho Young YHIM
;
Hee Sun KIM
;
Jeong A KIM
;
Deok Hwan YANG
;
Jae Yong KWAK
Author Information
- Publication Type:Original Article
- Keywords: Cyclophosphamide; Dexamethasone, cytarabine, and cisplatin; Mobilization; Lymphoma, non-Hodgkin; Autologous stem cell transplantation
- MeSH: Blood Component Removal; Cisplatin*; Cyclophosphamide; Cytarabine*; Dexamethasone*; Doxorubicin; Febrile Neutropenia; Granulocyte Colony-Stimulating Factor; Hematopoietic Stem Cell Mobilization*; Humans; Lymphoma; Lymphoma, Non-Hodgkin*; Multivariate Analysis; Prednisone; Stem Cell Transplantation*; Stem Cells*; Vincristine
- From:The Korean Journal of Internal Medicine 2018;33(6):1169-1181
- CountryRepublic of Korea
- Language:English
- Abstract: BACKGROUND/AIMS: 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’s lymphoma (NHL) is limited. METHODS: Consecutive patients with aggressive NHL treated with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or rituximab-CHOP who underwent chemomobilization using HDC or DHAP plus granulocyte-colony stimulating factor (G-CSF) for up-front ASCT were enrolled from three institutions between 2004 and 2014. RESULTS: Ninety-six patients (57 men) were included. Sixty-five patients (67.7%) received HDC; and 31 (32.3%), DHAP. The total CD34+ cells mobilized were significantly higher in patients receiving DHAP (16.1 vs. 6.1 × 106/kg, p = 0.001). More patients achieved successful mobilization with DHAP (CD34+ cells ≥ 5.0 × 106/kg) compared to HDC (87.1% vs. 61.5%, respectively; p = 0.011), particularly within the first two sessions of apheresis (64.5% vs. 32.3%, respectively; p = 0.003). Mobilization failure rate (CD34+ cells < 2.0 × 106/kg) was significantly higher in patients receiving HDC (20.0% vs. 3.2%, p = 0.032). On multivariate analysis, the DHAP regimen (odds ratio, 4.12; 95% confidence interval, 1.12 to 15.17) was an independent predictor of successful mobilization. During chemomobilization, patients receiving HDC experienced more episodes of febrile neutropenia compared to patients receiving DHAP (32.3% vs. 12.9%, p = 0.043). CONCLUSIONS: The DHAP regimen was associated with a significantly higher efficacy for stem cell mobilization and lower frequency of febrile neutropenia. Therefore, DHAP plus G-CSF is an effective for mobilization in patients with aggressive NHL who were candidates for up-front ASCT.
