BACKGROUND: Salvage therapy for patients with refractory/relapsed B-cell 
non-Hodgkin lymphoma (NHL) is based on polychemotherapy, followed by high-dose 
therapy and autologous stem cell transplantation in eligible patients 
(HDT/ASCT). R-DHAP combines rituximab with cisplatin, cytarabine, and 
dexamethasone.
PATIENTS AND METHODS: We substituted cisplatin with oxaliplatin to avoid 
nephrotoxicity and retrospectively analyzed a large series of 91 patients with 
refractory/relapsed B-cell NHL to evaluate toxicities, response rates (RRs), and 
survival. Median age at R-DHAX (rituximab/dexamethasone/cytarabine/oxaliplatin) 
treatment was 60 years (range, 28-82 years). Renal insufficiency was present in 
18 patients. The most frequent histologic subtypes were diffuse large B-cell 
lymphoma (n = 42) and follicular lymphoma (n = 30). Seventeen patients (19%) 
were naive to rituximab at time of R-DHAX.
RESULTS: Grade III/IV toxicities were mainly hematologic, including anemia (n = 
9), neutropenia (n = 44), and thrombocytopenia (n = 47). Grade I/II neurologic 
toxicities, sensitive or motor, were observed, and these were mainly transient 
except for 3 cases of motor neuropathy associated with previous exposure to 
vincristine. Neither renal toxicities nor degradation of previous renal 
insufficiency were observed. The overall RR was 75%, with a complete RR of 57%, 
with no statistical difference between patients previously treated with 
rituximab versus without rituximab. At a median follow-up of 23 months, 2-year 
probability rates of overall survival and progression-free survival were 75% and 
43%, respectively, with a significant difference between patients treated with 
HDT/ASCT and patients not eligible for HDT/ASCT.
CONCLUSION: R-DHAX is an efficient regimen in patients with relapsed/refractory 
B-cell NHL even in elderly patients if hematologic toxicities are closely 
managed.