DHAP chemotherapy is a combination treatment regimen that uses multiple drugs to disrupt cancer cell growth and division. As a systemic treatment, it circulates through the bloodstream, reaching cancer cells wherever they may be located. This regimen is used for specific cancer types.
Understanding DHAP Chemotherapy
DHAP is an acronym for a chemotherapy regimen including Dexamethasone, high-dose Cytarabine (also known as Ara-C), and Cisplatin. Dexamethasone is a corticosteroid that enhances chemotherapy effectiveness and manages side effects like nausea. Cytarabine is an antimetabolite that interferes with DNA synthesis, preventing cancer cells from dividing and growing. Cisplatin is a platinum-based antineoplastic agent that damages cancer cell DNA, leading to their death.
These drugs collectively target rapidly dividing cells, a characteristic of cancer cells. DHAP is often categorized as “salvage” or “second-line” chemotherapy, meaning it is used when initial treatments have not been successful or when the cancer has returned. The regimen aims to induce remission, often as a preparatory step for further treatments like autologous stem cell transplantation.
Medical Conditions Treated with DHAP
DHAP chemotherapy is used for certain types of lymphomas that have relapsed or are refractory to initial treatments. This includes high-grade non-Hodgkin lymphoma and Hodgkin lymphoma that has returned or progressed after previous therapy. It is considered for patients fit enough for high-dose chemotherapy and potential autologous stem cell transplant.
The regimen offers a potent combination of drugs to overcome resistance to prior treatments, aiming to reduce tumor burden and achieve remission. While primarily used for lymphomas, DHAP may be considered for other cancers in specific situations.
The DHAP Treatment Process
DHAP chemotherapy involves a multi-day cycle. Patients receive cisplatin as an intravenous drip, lasting up to 24 hours on Day 1. Dexamethasone is taken daily as oral tablets or given intravenously for four days. On Day 2, high-dose cytarabine is administered as two intravenous infusions, 12 hours apart, each lasting 2 to 3 hours.
Treatment is given in 3-week cycles, with patients undergoing 2 to 6 cycles, potentially up to 5 months. Due to high-dose cytarabine and the need for close monitoring, patients often require an inpatient hospital stay, especially during initial days. Blood tests are performed before each cycle to ensure safe treatment.
Common Side Effects and Management
DHAP chemotherapy causes several common side effects requiring careful management. Blood-related side effects include neutropenia (reduced white blood cell count), increasing infection risk, and anemia (low red blood cell count), causing fatigue and breathlessness. Neutropenia is managed with antibiotics or growth factors like G-CSF. Severe anemia may require blood transfusions.
Gastrointestinal issues are frequent, such as nausea, vomiting, and diarrhea. Anti-sickness medications are routinely prescribed to prevent or control nausea and vomiting; patients are advised to take them as directed, even if not feeling sick. Diarrhea management includes staying hydrated and reporting persistent symptoms to the medical team. Mouth sores and ulcers can also occur, managed by good oral hygiene, plenty of fluids, and prescribed mouthwashes.
Neurological side effects include changes in consciousness, drowsiness, slurred speech, or flu-like symptoms like fever, muscle aches, and bone pain, especially 6 to 12 hours after cytarabine. Steroid eye drops prevent and manage sore or itchy eyes, a common cytarabine side effect. Cisplatin can cause kidney damage, so patients receive intravenous fluids before and after treatment to protect kidney function and maintain electrolyte balance. Kidney function and blood sugar levels are regularly monitored, as dexamethasone can elevate blood sugar.
Life During and After DHAP Treatment
DHAP treatment requires adjustments to daily life. Patients maintain good hygiene, including regular hand washing, to reduce infection risk from a weakened immune system. Monitoring body temperature and reporting infection signs like fever or chills is important. Nutrition advice includes eating small, frequent meals and staying hydrated to combat nausea and prevent dehydration.
Emotional and psychological support are important during and after treatment. Patients experience mood swings, irritability, and energy changes due to medications, particularly dexamethasone. Open communication with the medical team, family, and support groups helps manage these emotional shifts. Physical activity, even gentle exercise like walking, is beneficial, but should be discussed with the healthcare provider.
After completing DHAP, follow-up appointments monitor recovery, assess treatment effectiveness, and manage lingering side effects. Recovery varies, but patients should expect gradual improvement. Inform all healthcare professionals, including dentists, about previous chemotherapy. Discuss contraception, as pregnancy avoidance is advised during and for a period after treatment.