Response to ICE (Ifosfamide, Carboplatin, Etoposide) vs DHAP (Dexamethasone, Cytarabine Cisplatin) as Salvage Chemotherapy in Patients with Relapsed/Refractory Lymphomas: An Experience of a Tertiary Care Center

Introduction:
Lymphoma is the sixth most common cancer in the world. Hodgkin's lymphoma is the third most common lymphoma in developing countries and the second most common lymphoma in industrialized countries. Non-Hodgkin's lymphomas are the eighth-most prevalent malignancy in females and the eleventh in males. No research comparing DHAP versus ICE as salvage chemotherapy regimens for relapsed or refractory lymphomas has yet been conducted in Pakistan. This study aims to compare the response of ICE versus DHAP as salvage chemotherapy in patients with relapsed/refractory lymphomas presenting at a tertiary care center in Karachi, Pakistan.
Methods:
A prospective follow-up study was conducted at the tertiary care hospital Karachi, Pakistan from 2019 to 2020. Total 58 lymphoma patients after 1 line chemotherapy, 9 with early relapse, 29 with late relapse, and 20 with refractory lymphoma who received DHAP, or ICE were included in the study. The treatment response was evaluated after two cycles of salvage chemotherapy using WHO assessment criteria and Cox regression was used to determine the hazard ratios considering p-value ≤0.05 significant. STATA v 16.0 was used to analyze the data.
Results:
Of 58 patients, 19 (32.8%) patients achieved CR, and 8 (13.8%) patients achieved PR, leading to an overall response rate of ORR of 46.6%. In the ICE group response was assessed in 19 patients, overall response was 42.1%, CR was 31.6% and PR was 10.5%. In the DHAP group response was evaluated in 39 patients, overall response rate was 48.7%, CR was 33.3% and PR was 15.4%. The overall response rate for DHAP was slightly higher than ICE, but the difference was statistically insignificant (p=0.78) but the hazard ratio for survival in patients with relapsed/refractory lymphomas received DHAP was 1.40 times (95% CI: 1.27-3.63, p=0.001) compared to patients received ICE as salvage chemotherapy.
Discussion:
DHAP seems to have a marginally better overall response rate than the ICE regimen in patients with refractory or relapsed lymphoma. However, the toxicity profile of patients in both groups was similar.