Assessment of Effectiveness and Adverse Effect of New Combination Chemotherapy (irinotecan, cisplatin, and dexamethasone) in Relapse and Refractory Hodgkin Lymphoma

Mahdi Tabarraee; Atefeh Rezaee; Sara Abolghasemi; Mojtaba Ghadiany; MariaTavakoli Ardakani; Mahshid Mahdizadeh; Neda Hamidi; Katayoon Ghasemi

doi:10.18502/ijhoscr.v17i3.13309

Mahdi Tabarraee Department of Hematology-Oncology, Shahid Beheshti University of Medical Sciences, Taleghani Hospital, Tehran, Iran
Atefeh Rezaee Department of Hematology-Oncology, Ahvaz Jondishapur University of Medical Sciences, Shahid Baghaei Hospital, Ahvaz, Iran
Sara Abolghasemi Department of Infection, Taleghani Hospital, Tehran, Iran
Mojtaba Ghadiany Department of Hematology-Oncology, Shahid Beheshti University of Medical Sciences, Taleghani Hospital, Tehran, Iran
MariaTavakoli Ardakani Department of Bone Marrow Transplant, Shahid Beheshti University of Medical Sciences, Taleghani Hospital, Tehran, Iran
Mahshid Mahdizadeh Department of Bone Marrow Transplant, Shahid Beheshti University of Medical Sciences, Taleghani Hospital, Tehran, Iran
Neda Hamidi Department of Hematology-Oncology, Shahid Beheshti University of Medical Sciences, Taleghani Hospital, Tehran, Iran
Katayoon Ghasemi Department of Hematology-Oncology, Hormozgan University of Medical Sciences, Shahid Mohammadi Hospital, Bandar Abbas, Iran

DOI: https://doi.org/10.18502/ijhoscr.v17i3.13309

Keywords: Relapse; Refractory; Hodgkin lymphoma; Irinotecan; Cisplatin; Salvage chemotherapy

Abstract

Background: Chemotherapy with adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD regimen) cannot cure all patients with Hodgkin lymphoma. In this study, we evaluated the efficacy and adverse effect of a new regimen consist irinotecan, cisplatin, and dexamethasone (ICD) in relapsed and refractory Hodgkin lymphoma as the second to fifth line of treatment.

Materials and Methods: We performed a retrospective study in 26 relapsed or refractory patients with Hodgkin lymphoma receiving at least the first-line chemotherapy regimen (ABVD) and (ICD) as salvage therapy in Thaleghany Hospital from 2012 to 2018. This regimen consisted of irinotecan 65mg/m2 D1, D8, cisplatin 30mg/m2 D1, D8, and dexamethasone 40mg D1, 2, 8, and 9 was administered every 3 weeks for 6 cycles. Treatment was discontinued in cases of disease progression or severe toxicity. Response to treatment was evaluated after two cycles. Patients with complete and partial remission were candidate high dose chemotherapy and autologous stem cell transplantation. Twenty-four patients were enrolled in the study. The mean age of 22 patients was 31.5 (19-67) years. Seven patients (29.1%) were in the first recurrence, and 17 (70.8%) were in the second or subsequent recurrence.

Results: According to this study, three patients (12.5%) had complete response, 13 (45%) had partial response, four (16.6%) had stable disease, and four (16.6%) had progressive disease. Nine patients (37.5%) received high-dose chemotherapy and autologous stem cell support after ICD regimen. None of the cycles of chemotherapy were delayed due to treatment-related adverse event. Overall survival after six months in all patients was 91%, and mortality rate was 8.3% at the end of the study.

Conclusion: The goal of salvage chemotherapy in relapsed or refractory Hodgkin Lymphoma is achieving CR or PR preparation patients for stabilization with BMT. Thus, we recommend ICD as one of the most effective protocols with overall response rate of 66% in this population.