ASHAP - an effective salvage therapy for recurrent and refractory malignant lymphomas

Background: This study was performed to examine the efficacy and toxicity o f the combination of adriamycin (ADR), methylprednisolone (solumedrol), cyt arabine (Ara-C), and cisplatin (CDDP) in patients with recurrent and refrac tory malignant lymphomas. Patients and methods: Sixty-five patients with Ho dgkin's disease (HD) (n=14) or non-Hodgkin's lymphomas (NHL) (n = 51) were enrolled in the study. The ASHAP therapy consisted of ADR (40 mg/m(2) by co ntinuous infusion (CI) over 96 h), methylprednisolone (500 mg i.v., days 1- 5), Ara-C (2 g/m(2) as a 2-h infusion on day 5), and CDDP (100 mg/m2 by CI over 96 h). Results: Twenty-five patients (38%) achieved complete remission (CR) and 20 (31%) were taken into partial remission (PR) for an overall re sponse rate of 69%. Thirty-two patients with CII or PR following ASHAP unde rwent high-dose therapy (HDT) with subsequent hematopoietic stem cell trans plantation. After a median follow-up of 52 months, 13 patients are in conti nuous CR (CCR), the 3-year event-free survival (EFS) was 30% for responders and 21% for all patients. The median overall survival (OS) was 12 months ( range 0-70 months), and the OS rate after 3 years was 32%. Unfavorable prog nostic factors for EFS and OS by univariate analysis were an elevated value of the serum lactate dehydrogenase and refractory lymphoma. The most frequ ently observed side effects following ASHAP were leukocytopenia and thrombo cytopenia of World Health Organization (WHO) grades III/IV in approximately 80% of all courses. Non-hematological toxicities such as gastrointestinal side effects, infections, mucositis, renal and neurotoxicity occurred more rarely and reached WHO grades III/IV only occasionally. No treatment-relate d mortality with ASHAP was observed. Conclusions: ASHAP is an effective and moderately toxic salvage therapy for patients with recurrent or refractory IID and NHL. The results in patients responding to ASHAP and afterwards un dergoing HDT with stem cell support are comparable with other established p rotocols and indicate an improvement in survival if HDT is carried out as i ntensification.