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1506 Minimal Renal Toxicity after Rituximab DHAP with a Modified Cisplatin Application Scheme in Patients with Relapsed and Refractory Diffuse Large B-Cell Lymphoma

Lymphoma: Chemotherapy, excluding Pre-Clinical Models
Program: Oral and Poster Abstracts
Session: 623. Lymphoma: Chemotherapy, excluding Pre-Clinical Models: Poster I
Saturday, December 5, 2015, 5:30 PM-7:30 PM
Hall A, Level 2 (Orange County Convention Center)

Katharina Lisenko, MD1*, Fabienne McClanahan, MD, PhD2*, Tilman Schöning, MD3*, Mark-Alexander Schwarzbich, MD4*, Martin Cremer, MD5*, Tobias Dittrich, MD6*, Anthony D. Ho, MD7 and Mathias Witzens-Harig, MD8*

1Department of Hematology, University Hospital, Heidelberg, Germany
2Centre for Haemato-Oncology, Queen Mary University of London, London, United Kingdom
3University Pharmacy, University Hospital Heidelberg, Heidelberg, Germany
4Department of Hematology, University of Heidelberg, Heidelberg, Germany
5Department of Hematology, University Hospital Heidelberg, Heidelberg, Germany
6Amyloidosis Center, University Hospital Heidelberg, Heidelberg, Germany
7Dept. Med. V, University Hospital Heidelberg, Heidelberg, Germany
8Dep. Med. V, University Hospital Heidelberg, Heidelberg, Germany

BACKGROUND: Rituximab (R) in combination with DHAP is a widely accepted salvage regimen in patients with relapsed/refractory diffuse large B-cell lymphoma (DLBCL). DHAP combines cisplatin (100 mg/m2) typically administered intravenously (i. v.) by continuous infusion over 24 hours, followed on day 2 by cytarabine (2 g/m2) in a 3-hour infusion repeated after 12 hours, and oral administration of dexamethasone (40 mg/d) for 4 consecutive days. A common adverse effect of this protocol consists of renal toxicity which may result in dose reduction or treatment discontinuation. Therefore novel approaches to overcome renal toxicity of R-DHAP are urgently warranted. Assuming that a lower single dose of cisplatin over several days would reduce renal toxicity, our institution has chosen to administer cisplatin at a dosage of 25 mg/m2per day as a 3-hour infusion over 4 consecutive days. In this study we systematically examine efficacy and renal toxicity of this modified R-DHAP regimen.

METHODS: We retrospectively analyzed data of 122 patients with relapsed/refractory DLBCL who were treated at our institution from July 2002 to July 2013. Patients were grouped according to the number of R-DHAP courses applied and renal function was evaluated in each subgroup. Creatinine serum levels before each R-DHAP cycle and two to three weeks after the last R-DHAP were assessed and GFR was calculated according to the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation.

RESULTS: Overall, 256 R-DHAP cycles were administered. 31 (25%), 61 (50%), 14 (12%) and 16 (13%) patients received one, two, three or four R-DHAP courses, respectively. Dose adjustments needed to be applied in only 5 (4%) patients who in total received 11 R-DHAP courses. A step-by-step evaluation of renal function after each R-DHAP course revealed that a GFR decrease can be observed after each chemotherapy cycle. However, in none of the subgroups GFR was lower than 60 ml/min/1.73 m2. In most patients, only renal impairment stage I and II was observed. Renal impairment stage III was observed in 12 patients (10%) and stage IV only in one patient (1%). The overall response rate of the modified R-DHAP protocol was 54% (CR 17%, CRu 5%, PR 32%, SD 15% and PD 29%, not known 4%).

CONCLUSION: A modified R-DHAP regimen with administration of cisplatin 25 mg/m2 over 4 consecutive days is effective and safe in relapsed/refractory DLBCL and leads only to minimal renal toxicity.

Disclosures: Witzens-Harig: Pfizer: Honoraria , Research Funding ; Roche: Honoraria .

*signifies non-member of ASH