Korean J Intern Med.  2018 Nov;33(6):1169-1181. 10.3904/kjim.2016.163.

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

Affiliations
  • 1Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea. jykwak@jbnu.ac.kr
  • 2Research Institute of Clinical Medicine of Chonbuk National University and Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea.
  • 3Chonbuk National University College of Nursing, Jeonju, Korea.
  • 4Division of Hematology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
  • 5Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Hwasun, Korea.

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.

Keyword

Cyclophosphamide; Dexamethasone, cytarabine, and cisplatin; Mobilization; Lymphoma, non-Hodgkin; Autologous stem cell transplantation

MeSH Terms

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
Cisplatin
Cyclophosphamide
Cytarabine
Dexamethasone
Doxorubicin
Granulocyte Colony-Stimulating Factor
Prednisone
Vincristine
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