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
Citation
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.