E-SHAP - AN EFFECTIVE TREATMENT IN SELECTED PATIENTS WITH RELAPSED NON-HODGKINS-LYMPHOMA

Background: The optimal treatment of relapsed or refractory non-Hodgki n's lymphoma is unknown. The reported encouraging results of a salvage regimen, E-SHAP (etoposide 40 Mg/M2/day x 4, methyl prednisolone 500 mg daily x 4, cytosine arabinoside 2 gm/m2 one dose and cisplatinum 25 mg/m2/day x 4), at the M.D. Anderson Hospital in Texas, which resulte d in a 65% response rate, could not be reproduced in the United Kingdo m (0% response). Patients and methods: Twenty-six patients with relaps ed (n = 16) or refractory (n = 10) non-Hodgkin's lymphoma were treated at our Centre by a modified E-SHAP regimen (cytosine arabinoside 1 gm /m2 one dose). The treatment was intended as remission induction befor e BMT (n = 16), as salvage by itself (n = 5) and for palliation of sym ptoms (n = 5). Results: The overall response rate was 72% (CR = 7 and PR = 11). A comparison of Kaplan-Meier curves showed a statistically s ignificant improvement in median relapse-free survival in patients who had previously achieved CR (p = 0.0012), no bulky disease (P = 0.0006 ) and no B-symptoms (P = 0.0004). The toxicity was acceptable: 8 insta nces of febrile neutropenia, 2 of reversible renal impairment and 2 sy mptomatic electrolyte abnormalities. No fatal toxicities were encounte red. The median time to treatment failure was 191 days and median over all survival was 190 days. Conclusions: E-SHAP is an active combinatio n chemotherapy when used as a salvage regimen or for remission inducti on before bone marrow transplantation in selected patients with relaps ed non-Hodgkin's lymphoma. Patients who previously achieved CR, with l ow tumour burden and no B-symptoms are the best candidates for this tr eatment. It has a limited palliative effect.