Dexamethasone, high-dose cytarabine, and oxaliplatin (DHAOx) as salvage treatment for patients with initially refractory or relapsed non-Hodgkin's lymphoma

Background: Dexamethasone, cytarabine (ara-C), and cisplatin (DHAP) can be used effectively to treat patients with non-Hodgkin's lymphoma (NHL). We hy pothesized that substitution of cisplatin by oxaliplatin (L-OHP) could resu lt in less toxicity and greater efficacy. L-OHP is active in patients with lymphoma. It produces mild myelosuppression and is devoid of renal toxicity . We report on a phase II study of dexamethasone, high-dose ara-C, and L-OH P (DHAOx) used to treat patients with NHL who were previously treated with chemotherapy. Patients and methods: Fifteen patients were given DHAOx. They had failed to achieve a CR with initial chemotherapy or had recurrent disease. DHAOx con sisted of dexamethasone, 40 mg/day (days 1 to 4); L-OHP, 130 mg/m(2) (day 1 ); and ara-C, 2000 mg/m(2) every 12 h (day 2). Treatment was repeated every 21 days. Results: Patients received a median of four courses of DHAOx. Myelosuppress ion and transient sensory peripheral neuropathy were the most prominent tox ic effects. Serum creatinine levels did not increase in patients with norma l renal function, nor in patients who had renal impairment before DHAOx. Th e median follow-up time from the start of DHAOx treatment was 17 months. Ei ght patients (53%) achieved a CR, and three patients (20%) had a PR. Respon ses were achieved by patients with lymphomas of various histologies that in cluded mainly the follicular subtype, and by patients with and without resi stance to prior chemotherapy. None of the eight responders have relapsed fr om CR at 4+, 6+, 14+, 15+, 19+, 20+, 24+, and 24+ months. They had various types of therapy after DHAOx. Disappearance of molecular markers was observ ed in all four patients who achieved a CR and whose tumor cells carried mol ecular abnormalities. Conclusion: DHAOx possesses characteristics of toxicity which compare favor ably to those reported with DHAP, and it is useful as a salvage treatment f or patients with NHL. Larger studies are required to establish the therapeu tic potential of the regimen.