Substituting oxaliplatin for cisplatin in rituximab, cisplatin, dexamethasone, and high-dose cytarabine (R-DHAP) regimens for treating B-cell lymphoma may lead to reduced nephrotoxicity, according to research published in the European Journal of Haematology.

R-DHAP is a standard treatment for patients with mantle cell lymphoma and for those with relapsed non-Hodgkin lymphoma (NHL). While oxaliplatin is frequently substituted for cisplatin (R-DHAOx) to mitigate the risk of nephrotoxicity, no previous study has directly compared the 2 regimens.

In a retrospective analysis, researchers in France compared the efficacy and nephrotoxicity of R-DHAP vs R-DHAOx in patients treated for NHL between 2007 and 2014. Endpoints included remission status, event-free survival (EFS), overall survival (OS), and evidence of renal injury, which was determined by creatinine levels.

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The analysis included 57 patients (70.2% men; median age, 60 years), 22 patients received R-DHAP and 35 patients received R-DHAOx at time of inclusion and 6 patients in the R-DHAP group switched to R-DHAOx because of renal toxicity. Baseline characteristics, including creatinine levels, were similar in both groups.

Response rates, EFS, and OS were similar between the 2 groups, with a nonsignificant EFS improvement in the R-DHAOx group vs the R-DHAP group (P =.18). Eight complete responses (36.4%) were noted in the R-DHAP group vs 14 (40%) in the R-DHAOx group. Of the 193 recorded chemotherapy cycles, 74.1% were administered to patients receiving R-DHAOx; however, nephrotoxicity was much more common in the R-DHAP group than in the R-DHAOx group (68% vs 7.7%, respectively; P <.001). When patients were grouped by presence or lack of nephrotoxicity, the only significant difference was treatment, with R-DHAP predicting presence of the event.

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Grade 3 to 4 hematologic toxicity rates were similar between groups, although more individuals treated with R-DHAP needed blood transfusion. In addition, OS outcomes were similar in both groups. EFS improvements were reported among participants in the R-DHAOx group, but the values were not statistically significant.

“[P]reserving renal function is a serious issue concerning both short and long-term morbidity and mortality,” the authors wrote. “Prospective larger studies including a pharmaco-economic analysis are warranted to confirm these results.”


Lacout C, Orvain C, Seegers V, et al. R‐DHA‐oxaliplatin (R‐DHAOx) versus R‐DHA‐cisplatin (R‐DHAP) regimen in B‐cell lymphoma treatment [published online April 17, 2020] . Eur J Haematol. doi: 10.1111/ejh.13429