Carboplatin instead of cisplatin in combination with dexamethasone, high-dose cytarabine with or without rituximab (DHAC+/-R) is an effective treatment with low toxicity in Hodgkin's and non-Hodgkin's lymphomas.

  • Tessoulin B.
  • Thomare P
  • Delande E.
  • Moynard J.
  • Gastinne T.
  • Moreau A.
  • Bossard C.
  • Mahé B.
  • Blin N.
  • Dubruille V.
  • Touzeau C.
  • Boudreault J. S.
  • Perrin F.
  • Lok A
  • Guillaume T.
  • Garnier A
  • Peterlin P
  • Gallas P
  • Chevallier P
  • Moreau P.
  • Le Gouill Steven
  • Tessoulin A
  • Delande P
  • Moynard P
  • Gastinne A
  • Bossard P
  • Mahé Annaïg
  • Blin A
  • Dubruille A
  • Touzeau A
  • Boudreault A
  • Perrin P
  • Guillaume Alain

  • Carboplatin
  • Cytarabine
  • DHAC
  • Lymphoma

ART

The DHAP regimen (high-dose cytarabine in combination with dexamethasone and cisplatin) with or without rituximab (DHAP+/-R) is one of the most common regimens in daily practice. It is considered the standard treatment for relapse or refractory Hodgkin's and non-Hodgkin's lymphoma (NHL). Cisplatin nephrotoxicity is a major concern, and other platinum compounds are being tried. We performed a monocentric retrospective analysis to evaluate the use of carboplatin, so-called DHAC+/-R regimen. The purpose was to assess the toxicity of the DHAC+/-R regimen in real-life. The Dexamethasone, Cytarabine, Carboplatin (DHAC) regimen consisted of carboplatin AUC = 5 mg/ml/min (targeted area under the curve with Calvert's formula) on day 1, cytarabine 2 g/m(2) twice a day on day 2 and IV dexamethasone 40 mg from days 1 to 4. Rituximab was administrated at 375 mg/m(2) on day 1 for CD20+ NHL. The interval between courses was 21 days. During the period considered, 199 patients received DHAC+/-R. For the entire cohort, median follow-up is 24 months (range, 2-82), median OS is not reached (NR), estimated 2-year OS is 75% (95% CI, 69-83) and median progression-free survival (PFS) is 46 months (95% CI, 22-NA). Of 144 patients scheduled for autologous stem cell transplantation (ASCT), 102 (71%, NA = 2) were in response after DHAC+/-R and all except 4 underwent ASCT. Grade ≥ 3 haematological toxicities were mainly thrombocytopenia (n = 101) and anaemia (n = 95). Grade ≥ 3 neutropenia occurred in 10 patients. No grade ≥ 3 renal and one grade 3 neurological toxicity were reported. DHAC+/-R is feasible in daily practice, provides good response rates and jeopardises neither stem cell collection nor ASCT.