Retrospevtive analysis of hematologic toxicity and transfusion requirements of the ESHAP and DHAP salvage chenotherapy regimens in relaps/refractory lymphoma cases

The aim of the study was to determine the hematologic and non hematological toxicity of two different platinum based chemotherapy, frequently used in relaps/refractory lymphoma cases in Akdeniz University School of Medicine Hospital. We evaluated 51 HL and NHL patients who were treated with DHAP and ESHAP salvage chemotherapy regimens (33 ESHAP, 18 DHAP) during the period from January 2000 to July 2010 in Hematology Discipline of Akdeniz University School of Medicine. These patients had totally 153 cycles salvage chemotherapy regimens (91 cycles of ESHAP, 62 cycles of DHAP). Datas were collected from Hematology Discipline recordings, hospital archive and electronic patient file system MEDIHASTA as a retrospective investigation. There is no significant differences in serious hematologic toxicities (grade 3-4). Platelet transfusions in 28 (55%) patients and red blood cell transfusions in 27 (53%) patients are performed. Febril neutropenia occured in 11 (21.5%) patients. Treatment related death was not seen in any patient. With univariate analysis renal toxicity, platelet transfusion frequency, febril neurtopenia and treatment delay due to toxicity were seen more in DHAP group. With the multivariate logistic regression analysis being in DHAP group is found as an independent risk factor for renal toxicity (p=0.03) however the number of platelet transfusion, febril neutropneia, treratment delay due to toxicity have lost their statistic significance. First cycle interval in inpatient group compared to outpatient group and in ESHAP group compared to DHAP group were found significantly longer (p=0.03 and p=0.0082 respectively). Considering the diagnosis, the number of salvage chemotherapy cycles and the response state to initial regimen before the salvage treatment (primary resistant and early relaps) factors, significance is remained firm in DHAP group's favour for total response (p=0.04). There was no significant difference between two groups (ESHAP and DHAP) in terms of median survival (p=0.6). As a result, the efficiency of DHAP regimen superior to ESHAP regimen may be explained by the outpatient treatment on exact time. Outpatient DHAP regimen may be chosen in patients who can not take chemotherapy on time in hematology clinics having insufficient bedspace. Although hematologic and non hematologic toxicity profil is similar to ESHAP regimen, renal toxicity possibility should be considered. Key words: Lymphoma, DHAP, ESHAP, Toxicity