Background: The optimal treatment of relapsed or refractory non-Hodgkin's lymphoma is unknown. The reported encouraging results of a salvage regimen, E-SHAP (etoposide 40 mg/m2/day x 4, methyl prednisolone 500 mg daily x 4, cytosine arabinoside 2 gm/m2 one dose and cisplatinum 25 mg/m2/day x 4), at the M.D. Anderson Hospital in Texas, which resulted in a 65% response rate, could not be reproduced in the United Kingdom (0% response).
Patients and methods: Twenty-six patients with relapsed (n = 16) or refractory (n = 10) non-Hodgkin's lymphoma were treated at our Centre by a modified E-SHAP regimen (cytosine arabinoside 1 gm/m2 one dose). The treatment was intended as remission induction before BMT (n = 16), as salvage by itself (n = 5) and for palliation of symptoms (n = 5).
Results: The overall response rate was 72% (CR = 7 and PR = 11). A comparison of Kaplan-Meier curves showed a statistically significant improvement in median relapse-free survival in patients who had previously achieved CR (p = 0.0012), no bulky disease (P = 0.0006) and no B-symptoms (P = 0.0004). The toxicity was acceptable: 8 instances of febrile neutropenia, 2 of reversible renal impairment and 2 symptomatic electrolyte abnormalities. No fatal toxicities were encountered. The median time to treatment failure was 191 days and median overall survival was 190 days.
Conclusions: E-SHAP is an active combination chemotherapy when used as a salvage regimen or for remission induction before bone marrow transplantation in selected patients with relapsed non-Hodgkin's lymphoma. Patients who previously achieved CR, with low tumour burden and no B-symptoms are the best candidates for this treatment. It has a limited palliative effect.