R-DHA + Platinum (R-DHAP / R-DHAX)
R-DHA refers to a backbone of rituximab, dexamethasone, and cytarabine (Ara-C) combined with a platinum agent.
- Regimen Variants: The pharmacist will encounter two main variations based on the platinum agent used:
- R-DHAP: Uses cisplatin.
- R-DHAX: Uses oxaliplatin, often preferred to minimize cisplatin-related toxicities like nephrotoxicity.
- Place in Therapy:
- MCL Aggressive Induction: It is a preferred induction regimen, either as a standalone aggressive protocol or as a component of alternating regimens (like R-CHOP/R-DHAP).
- Salvage Therapy: It is also used as a second-line “salvage” regimen for patients with relapsed/refractory Diffuse Large B-cell Lymphoma (DLBCL) who are candidates for stem cell transplant.
- Pharmacist Note: The addition of high-dose cytarabine to intensive induction regimens has been specifically shown to improve outcomes in younger MCL patients.