Is ESHAP safe and effective as salvage therapy in Hodgkin lymphoma?

This study examined the safety and effectiveness of the chemotherapy ESHAP in Hodgkin lymphoma that had relapsed (returned), or that had not responded to treatment. This study concluded that ESHAP was safe and effective in these patients.

Hodgkin lymphoma is often curable. Some patients do not respond to treatment, or the cancer returns. These patients are generally treated with salvage chemotherapy (treatment to reduce tumor size) followed by high dose chemotherapy and a stem cell transplant (infusion of immature blood cells). Different salvage chemotherapy options lead to different response rates. These rates range from 43% to 88% depending on the study.

ESHAP is a combination of the chemotherapies etoposide, steroids, ara-C, and cisplatin. In studies where ESHAP was combined with other chemotherapies, response rates ranged from 39% to 81%. One small study of 22 patients examined ESHAP alone. 73% of patients showed a response to treatment. Larger studies are needed to understand the safety and effectiveness of ESHAP.

The current study explored the use of ESHAP as salvage chemotherapy before stem cell transplantation. This study examined the records of 82 patients who had not responded to treatment or who had relapsed. All patients were treated with ESHAP as salvage chemotherapy. Patients were followed for an average of 87 months.

After an average of 2 cycles of ESHAP, 50% saw a complete response (no cancer remaining) and 17% saw a partial response (tumor shrinkage). 22% of patients did not respond to treatment. 11% progressed.

91.5% of patients went on to stem cell transplant. The average time to disease progression was 52 months. Two-year overall survival (time from treatment until death from any cause) was 80.5%. Five-year overall survival was 72.6%.

The most common severe side effect was low platelet (type of blood cell involved in clotting) levels. This was experienced by 24% of patients. 18% experienced anemia (low levels of red blood cells). 10% experienced low white blood cell levels.

This study concluded that ESHAP was safe and effective in patients with Hodgkin lymphoma that had relapsed or had not responded to treatment.