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regimen-monograph
DHAP
Intent
Curative
Regimen Category
Evidence-Informed
Drugs Used
A - Regimen Name
DHAP Regimen
Dexamethasone-High dose ARA-C (Cytarabine)-PLATINOL® (CISplatin)
Disease Site
Hematologic - Lymphoma - Hodgkin's
Intent
Curative
Regimen Category
Evidence-Informed :
Regimen is considered appropriate as part of the standard care of patients; meaningfully improves outcomes (survival, quality of life), tolerability or costs compared to alternatives (recommended by the Disease Site Team and national consensus body e.g. pan-Canadian Oncology Drug Review, pCODR). Recommendation is based on an appropriately conducted phase III clinical trial relevant to the Canadian context OR (where phase III trials are not feasible) an appropriately sized phase II trial. Regimens where one or more drugs are not approved by Health Canada for any indication will be identified under Rationale and Use.
Rationale and Uses
Salvage therapy of aggressive histology lymphoma; third-line therapy for advanced Hodgkin's lymphoma.
B - Drug Regimen
| CISplatin
(Round to nearest 1 mg) |
100 mg /m² | IV continuous infusion over 24 hours | Day 1 |
|
(May give over 8 hours, as outpatient treatment) |
|||
| cytarabine | 2000 mg /m² | IV over 2 hours | Day 2 Q12H (for 2 doses of 2000 mg/m²) |
|
(continued on next page) |
|||
| dexamethasone
(Round to nearest 1 mg (if IV)) |
40 mg | IV / PO | Days 1 to 4 |
|
(Outpatient prescription in multiples of 4mg tablets)
|
|||
C - Cycle Frequency
REPEAT EVERY 28 DAYS
For a usual total of 4 to 6 cycles unless disease progression or unacceptable toxicity occurs
D - Premedication and Supportive Measures
Antiemetic Regimen:
High
Febrile Neutropenia Risk:
High
Other Supportive Care:
Use standard regimens for cisplatin pre-medication and hydration. See Cisplatin monograph.Also refer to CCO Antiemetic Summary
E - Dose Modifications
Doses should be modified according to the protocol by which the patient is being treated. The following recommendations are in use at some centres.
Dosage with toxicity
Hematologic Toxicities: See Appendix 6 for general recommendations.
Hepatic Impairment
No adjustment required for cisplatin. For cytarabine, reduce dose with impaired liver function (no details available; use with caution).
Renal Impairment
For cisplatin, renal function should have normalized before patients are retreated. If continued treatment is considered to be mandatory, the following dose modifications could be considered at the physician's discretion (Kintzel 1995).
|
Creatinine clearance
|
% previous dose
|
|
46-60
|
75%
|
|
30-45
|
50%
|
|
<30
|
Discontinue
|
For cytarabine, no adjustment required for standard doses. For high-dose therapy, since renal impairment (< 60 mL/min) is a risk factor for neurotoxicity, consider:
- dose reduction (2 g/m2→ 1 g/m2→ 0.1 g/m2/day CIV)
- schedule modification (i.e. from q12h to q24h)
F - Adverse Effects
Refer to CISplatin, cytarabine, dexamethasone drug monograph(s) for additional details of adverse effects
| Most Common Side Effects | Less Common Side Effects, but may be |
|
|
G - Interactions
Refer to CISplatin, cytarabine, dexamethasone drug monograph(s) for additional details
H - Drug Administration and Special Precautions
Refer to CISplatin, cytarabine, dexamethasone drug monograph(s) for additional details
I - Recommended Clinical Monitoring
Recommended Clinical Monitoring
- Blood glucose testing; baseline and regular
- CBC; baseline and before each cycle.
- Baseline and regular liver & renal function (including electrolytes and magnesium) tests and urinalysis.
- Pulmonary function exam; baseline and as clinically indicated
- Clinical toxicity assessment (including gastrointestinal, stomatitis, neurotoxicity, CNS toxicity, conjunctivitis, pulmonary toxicity and ototoxicity); at each visit
Grade toxicity using the current NCI-CTCAE (Common Terminology Criteria for Adverse Events) version
Suggested Clinical Monitoring
Audiogram; baseline and periodic
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J - Administrative Information
Approximate Patient Visit
Inpatient regimen; some centres have modified this regimen for outpatient treatment.
Pharmacy Workload (average time per visit)
28.583 minutes
Nursing Workload (average time per visit)
44.167 minutes
K - References
Cisplatin and cytarabine drug monographs, Cancer Care Ontario.
Velasquez WS, Cabanillas F, Salvador P, et al. Effective salvage therapy for lymphoma with cisplatin combination with high-dose Ara-C and dexamethasone (DHAP). Blood, 1988; 71: 117-122.
McLaughlin P, Velasquez WS, Redman Jr et al. Chemotherapy with Dexamethasone, high-dose cytarabine, and cisplatin for parenchymal brain lymphoma. Journal of National Cancer Institute 1988; 80 (17): 1408- 1412.
October 2017 Replaced regimen category with evidence-informed
M - Disclaimer
Regimen Abstracts
A Regimen Abstract is an abbreviated version of a Regimen Monograph and contains only top level information on usage, dosing, schedule, cycle length and special notes (if available). It is intended for healthcare providers and is to be used for informational purposes only. It is not intended to constitute or be a substitute for medical advice, and all uses of the Regimen Abstract are subject to clinical judgment. Such information is provided on an “as-is” basis, without any representation, warranty, or condition, whether express, or implied, statutory or otherwise, as to the information’s quality, accuracy, currency, completeness, or reliability, and Cancer Care Ontario disclaims all liability for the use of this information, and for any claims, actions, demands or suits that arise from such use.
Information in regimen abstracts is accurate to the extent of the ST-QBP regimen master listings, and has not undergone the full review process of a regimen monograph. Full regimen monographs will be published for each ST-QBP regimen as they are developed.
Regimen Monographs
Refer to the New Drug Funding Program or Ontario Public Drug Programs websites for the most up-to-date public funding information.
The information set out in the drug monographs, regimen monographs, appendices and symptom management information (for health professionals) contained in the Drug Formulary (the "Formulary") is intended for healthcare providers and is to be used for informational purposes only. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects of a particular drug, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for a given condition. The information in the Formulary is not intended to constitute or be a substitute for medical advice and should not be relied upon in any such regard. All uses of the Formulary are subject to clinical judgment and actual prescribing patterns may not follow the information provided in the Formulary.
The format and content of the drug monographs, regimen monographs, appendices and symptom management information contained in the Formulary will change as they are reviewed and revised on a periodic basis. The date of last revision will be visible on each page of the monograph and regimen. Since standards of usage are constantly evolving, it is advised that the Formulary not be used as the sole source of information. It is strongly recommended that original references or product monograph be consulted prior to using a chemotherapy regimen for the first time.
Some Formulary documents, such as the medication information sheets, regimen information sheets and symptom management information (for patients), are intended for patients. Patients should always consult with their healthcare provider if they have questions regarding any information set out in the Formulary documents.
While care has been taken in the preparation of the information contained in the Formulary, such information is provided on an “as-is” basis, without any representation, warranty, or condition, whether express, or implied, statutory or otherwise, as to the information’s quality, accuracy, currency, completeness, or reliability.
CCO and the Formulary’s content providers shall have no liability, whether direct, indirect, consequential, contingent, special, or incidental, related to or arising from the information in the Formulary or its use thereof, whether based on breach of contract or tort (including negligence), and even if advised of the possibility thereof. Anyone using the information in the Formulary does so at his or her own risk, and by using such information, agrees to indemnify CCO and its content providers from any and all liability, loss, damages, costs and expenses (including legal fees and expenses) arising from such person’s use of the information in the Formulary.
Last Updated: July 21, 2026
