Real-world outcomes of CHASE therapy as salvage or bridging treatment for relapsed or refractory non-Hodgkin lymphoma

CHASE (cyclophosphamide, high-dose cytarabine, dexamethasone, and etoposide) is an anthracycline- and platinum-free salvage regimen. This study evaluated the real-world efficacy and safety of CHASE in relapsed or refractory non-Hodgkin lymphoma (NHL), focusing on its role as salvage or bridging therapy before transplantation and cellular therapy (TCT). We retrospectively analyzed 53 patients with relapsed or refractory NHL who received CHASE at Jichi Medical University Hospital between 2014 and 2026. Double-refractory (DR) disease was defined as refractoriness to both anthracycline- and platinum-based regimens. Progression-free survival (PFS), overall survival (OS), response, TCT completion, and adverse events were assessed. The overall response and complete response rates were 47.2% and 32.1%, respectively. Among 43 patients considered eligible for TCT, 36 (83.7%) proceeded to TCT. The median PFS was 138 days. Poor performance status and DR disease were independently associated with shorter PFS. Although no patients with DR disease achieved complete response, selected patients with refractory disease proceeded to subsequent TCT. Among patients treated with CHASE as third-line therapy or later, the 3-year OS rates were 54.8% in those unresponsive to prior therapy and 54.3% in those with platinum-refractory disease. Severe hematologic toxicities were frequent, whereas severe nonhematologic toxicities were infrequent. CHASE may provide temporary disease control before transition to appropriate TCT in selected patients with relapsed or refractory NHL.