DHAP regimen plus G-CSF as salvage therapy and priming for blood progenitor cell collection in patients with poor prognosis lymphoma.

Abstract

We studied 14 patients affected by lymphoma to assess the toxicity, efficacy and mobilization capability of salvage DHAP regimen followed by G-CSF 5 micrograms/kg/day. Ten patients were affected by intermediate-grade NHL and 4 by HD; all of them were in relapse or in PR. We administered a total of 34 courses of DHAP plus G-CSF (median 2 per patient; range 1-5) and did not observe either life-threatening extrahematologic toxicity or severe infections during the short neutropenic period. A significant tumor burden reduction was observed in 86% of patients (50% CR, 36% PR). A total of 35 aphereses were performed (median 3 per patient; range 1-5). The hemopoietic progenitors showed a very rapid increase from day +11 with a synchronous and impressive peak on day +13. We collected a median of 2.6 x 10(6)/kg CD34+ cells, 10 x 10(4)/kg CFU-GM, 5 x 10(4)/kg BFU-E and 0.5 x 10(4)/kg CFU-GEMM per apheresis. All patients transplanted with PBPC had a rapid and sustained hematological recovery. The DHAP regimen followed by G-CSF proved to be a very effective and well-tolerated schedule for debulking disease before transplantation and for enhancing progenitor cell mobilization.