ESHAP versus IEV Chemotherapy for Relapsed or Refractory Hodgkin's and Non- Hodgkin's Lymphoma

Mehdi  Dehghani; Reza  Vojdani; Abolfazl  Khalafi-Nezhad; Mohammad Reza  Ravanbod; Mani  Ramzi; Shima  Dehdashti; Nasrin  Namdari

doi:10.18502/ijhoscr.v19i2.18552

Mehdi Dehghani Hematology Research Center, Department of Hematology and Medical Oncology, Shiraz University of Medical Sciences, Shiraz, Iran
Reza Vojdani Hematology Research Center, Department of Hematology and Medical Oncology, Shiraz University of Medical Sciences, Shiraz, Iran
Abolfazl Khalafi-Nezhad Department of Hematology and Medical Oncology, Shiraz University of Medical Sciences, Shiraz, Iran
Mohammad Reza Ravanbod Department of Hematology and Medical Oncology, Shiraz University of Medical Sciences, Shiraz, Iran
Mani Ramzi Hematology Research Center, Department of Hematology and Medical Oncology, Shiraz University of Medical Sciences, Shiraz, Iran
Shima Dehdashti Department of Hematology and Medical Oncology, Shiraz University of Medical Sciences, Shiraz, Iran
Nasrin Namdari Department of Hematology and Medical Oncology, Shiraz University of Medical Sciences, Shiraz, Iran

DOI: https://doi.org/10.18502/ijhoscr.v19i2.18552

Keywords: ESHAP; IEV; Hodgkin's lymphoma and non-Hodgkin’s lymphoma

Abstract

Background: High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) is the standard treatment for Hodgkin's lymphoma (HL) and non-Hodgkin's lymphoma (NHL) in cases of relapsed or refractory disease. Various salvage chemotherapy regimens have been introduced with specific response rates, toxicity profiles, costs, and stem cell damage before stem cell harvest. The optimal salvage regimen for these patients is unclear.

Materials and Methods: In this retrospective analysis, 276 patients with HL and NHL with relapsed or refractory disease after initial treatment that received ESHAP (etoposide, methylprednisolone, cytosine arabinoside, and platinum) or IEV (ifosfamide, epirubicin, etoposide) as salvage regimen were included. We aimed to compare the efficacy of these two chemotherapy regimens as a life-saving treatment in recurrent or refractory disease.

Results: The mean age of patients was 33.96 ± 12.39 years. Hodgkin's lymphoma accounted for 60.1% and non-Hodgkin lymphoma (DLBCL) accounted for 39.9% of patients. The overall response rate (ORR) was 79.8% (50% complete response (CR)) for patients with Hodgkin lymphoma who received the ESHAP and 85.6% (55.1% CR) for the IEV regimen. Patients with non-Hodgkin's lymphoma who received the ESHAP plus rituximab regimen had an ORR of 60.9% (CR 40.3%), and patients who received the IEV + Rituximab chemotherapy regimen had an ORR of 72.4% (CR 42.4%) (P = 0.03). However, the mortality rate was lower in patients who received the IEV chemotherapy regimen.

Conclusion: IEV treatment is superior to ESHAP in patients with recurrent or refractory Hodgkin's and non-Hodgkin's lymphoma.