Comparison of ICE (Ifosfamide-Carboplatin-Etoposide) Versus DHAP (Cytosine Arabinoside-Cisplatin-Dexamethasone) as Salvage Chemotherapy in Patients with Relapsed or Refractory Lymphoma.
Authors: Urun Yuksel , Abali Huseyin , Oksuzoglu Berna , Budakoglu Burcin , Yildirim Nuriye , Guler Tunc , Ozet Gulsum , Zengin Nurullah 
Published: October 2019

Background: High dose chemotherapy (HDCT) with autologous stem cell transplantation (ASCT) is currently the treatment of choice for relapsed or refractory lymphoma patients. However, the optimal salvage regimen for these patients is unclear. In this study, our aim was to compare the efficacy and toxicity profiles of DHAP and ICE regimens in the salvage treatment of relapsed and refractory lymphoma.

Patients and methods: In this retrospective analysis, 53 patients with primary refractory or relapsed Hodgkin’s disease (HD) (n=13) or non-Hodgkin lymphoma (NHL) (n=40) who received ICE or DHAP salvage regimen were included.

Results: Of 53 patients, 21 were female and the median age was 43 years. In the evaluable ICE group (n=22) rates of CR, PR, and ORR were 27%, 41% and 68% and in the DHAP group (n=27) rates of CR, PR, and ORR were 18%, 30% and 48% (p=0,24, for ORR). Of the 40 patients with NHL, 15 patients received ICE and 25 patients received DHAP. In the ICE group response could be evaluated in 12 patients, 3 (25%) achieved CR and 5 (42%) PR, leading to an ORR of 67%. In DHAP group, response could be evaluated in 24 patients, 5 (21%) achieved CR and 7 (29%) PR, which makes an ORR of 50%. Although response rate for ICE tends to be higher than DHAP, this difference was not statistically significant (p=0,48). Thirteen patients with HD had an ORR of 62%. One patient had a major response (CR + PR) in DHAP group (33%). In the ICE group of 10 patients with HD, ORR rate was 70%. The response rates for ICE for patients with NHL and HD were not statistically different (p=1,0). Toxicity with both regimens was within acceptable limits. The major grade III–IV toxicities for both groups were hematological (neutopenia and thrombocytopenia). The main non-hematological toxicity was renal and observed in 8 patients.

Conclusion: Although the toxicity profiles of both ICE and DHAP regimens were similar in the treatment of patients with relapsed or refractory HD or NHL, ICE seems to be more effective in terms of response rates than DHAP regimen in whole cohort and subgroups but this difference was not statistically significant.

Response of relapsed or refractory lymphoma patients to salvage chemotherapy regimens response ICE (n=22) n,% DHAP (n=27) n,% CR: complete response, PR: partial response, PBSC: peripheral blood stem cell CR 6 (27) 5 (18) PR 9 (41) 8 (30) CR+PR 15 (68) 13 (48) Failure 7 (32) 14 (52) Attempt to mobilize PBSC 8 (36) 2 (7) Successful mobilization 8 (36) 2 (7) Toxicity profiles of salvage chemotherapy regimens used for relapsed or refractory lymphoma patients ICE (n=25),n (%) DHAP (n=28), n (%) WHO: world health organization RBC: red blood cell, TX: transfusion PLT: platelet,G-CSF: granulocyte colony-stimulating factor No. of courses administered 1 3 (12) 7 (25) 2 5 (20) 4 (50) ≥3 17 (68) 7 (25) Total No. of courses administered 73 59 Toxicities (WHO grade III–IV) n=73 n=59 Neutropenia 13 (18) 8 (14) Thrombocytopenia 9 (12) 6 (10) Anemia 5 (7) 9 (15) Febrile neutopenia 6 (8) 6 (10) treated in patient 5 (7) 5 (8) Renal 4 (6) 4 (7) Total RBC TX (unit) 11 23 Total PLT TX (unit) 48 43 G-CSF 8 (11) 6 (10) TDDT 4 (6) 7 (12)