Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
5-Year IF – 2.0, IF – 1.9, JCI (2024) – 0.43
Scopus CiteScore – 4.3
Q1 in SJR 2024, SJR score – 0.598, H-index: 49 (SJR)
ICV – 161.00; MNiSW – 70 pts
Initial editorial assessment and first decision within 24 h

ISSN 1899–5276 (print), ISSN 2451-2680 (online)
Periodicity – monthly

Download original text (EN)

Advances in Clinical and Experimental Medicine

2015, vol. 24, nr 5, September-October, p. 783–789

doi: 10.17219/acem/34795

Publication type: original article

Language: English

Download citation:

  • BIBTEX (JabRef, Mendeley)
  • RIS (Papers, Reference Manager, RefWorks, Zotero)

Gemcitabine-Based Treatment in Poor-Prognosis Patients with Relapsed and Refractory Hodgkin Lymphoma and Non-Hodgkin Lymphoma – a Multicenter Polish Experience

Justyna Rybka1,B,C,D, Wojciech Jurczak2,B, Agnieszka Giza2,B, Ewa Paszkiewicz-Kozik3,B, Beata Kumiega4,B, Joanna Drozd-Sokołowska5,B, Aleksandra Butrym1,B, Kazimierz Kuliczkowski1,B,C,E, Tomasz Wróbel1,A,B,C,E,F

1 Department of Hematology, Wroclaw Medical University, Poland

2 Department of Hematology, Collegium Medicum, Jagiellonian University, Kraków, Poland

3 Department of Lymphoid Diseases, the Maria Sklodowska-Curie Memorial Institute and Center of Oncology, Warszawa, Poland

4 Department of Hematology, Brzozow Oncology Center, Brzozów, Poland

5 Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Poland

Abstract

Background. The treatment of patients with relapsed or refractory Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) remains challenging. Gemcitabine is a cytidine analog with a wide spectrum of antitumor activity. Gemcitabine treatment is widely used to treat patients with certain solid tumors and relapsed/refractory hematological malignancies. There are several reports indicating that this compound is active in lymphoid malignancies. In patients with relapsed or refractory HL and NHL, gemcitabine has demonstrated efficacy as a single agent and in combination with other cytostatics.
Objectives. The aim of the study was to analyze the efficacy and toxicity of gemcitabine-based chemotherapy in patients with relapsed or refractory lymphomas.
Material and Methods. The study evaluated 68 heavily pretreated patients with relapsed/refractory HL and NHL. The median age of the patients was 36 years. All the patients received gemcitabine-based chemotherapy (gemcitabine monotherapy or gemcitabine in combination with other cytostatics).
Results. The overall response rate was 46%. Complete response was achieved by 21% of the patients and partial response by 25%. Out of those who responded to gemcitabine treatment, 26 patients proceeded to autologous stem cell transplant. Toxicities connected with gemcitabine therapy occurred in 44% of the patients and included grade 3/4 neutropenia, thrombocytopenia and anemia.
Conclusion. The results suggest that gemcitabine-based salvage chemotherapy is effective and well tolerated in patients with relapsed/refractory HL and NHL.

Key words

Hodgkin lymphoma, gemcitabine, non-Hodgkin lymphoma, refractory disease, autologous stem cell transplant

References (24)

  1. Brice P: Managing relapsed and refractory Hodgkin lymphoma. Br J Haematol 2008, 141, 3–13.
  2. Appelbaum FR: Hematopoietic cell transplantation for non-Hodgkin’s lymphoma: yesterday, today, and tomorrow. J Clin Oncol 2008, 26, 2927–2929.
  3. Gandhi V, Plunkett W: Modulatory activity of 29,29-difluorodeoxycytidine on the phosphorylation and cytotoxicity of arabinosyl nucleosides. Cancer Res 1990, 50, 3675–3680.
  4. Hertel LW, Boder GB, Kroin JS: Evaluation of the antitumor activity of gemcitabine (29,29-difluoro-29- -deoxycytidine). Cancer Res 1990, 50, 4417–4422.
  5. Burris HA, Moore MJ, Andersen J: Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: A randomized trial. J Clin Oncol 1997, 15, 2403–2413.
  6. Sandler AB, Nemunaitis J, Denham C: Phase III trial of gemcitabine plus cisplatin vs. cisplatin alone in patients with locally advanced or metastatic non-small cell lung cancer. J Clin Oncol 2000, 18, 122–130.
  7. Von der Maase H, Hansen SW, Roberts JT: Gemcitabine and cisplatin versus methotrexate, vinblastine, doxorubicin, and cisplatin in advanced or metastatic bladder cancer: results of a large, randomized, multinational, multicenter, phase III study. J Clin Oncol 2000, 18, 3068–3077.
  8. Albain KS, Nag S, Calderillo-Ruiz G: Global phase III study of gemcitabine plus paclitaxel (GT) vs. paclitaxel (T) as frontline therapy for metastatic breast cancer (MBC): First report of overall survival. Proc. ASCO 22, No. 14S (July 15 Supplement), 2004, 510.
  9. Crump M, Baetz T, Couban S: Gemcitabine, dexamethasone, and cisplatin in patients with recurrent or refractory aggressive histology B-cell non-Hodgkin lymphoma: a phase II study by the National Cancer Institute of Canada Clinical Trials Group (NCIC-CTG). Cancer 2004, 101, 1835–1842.
  10. Bai B, Qiang H, Cai QQ: Promising long-term outcome of gemcitabine, vinorelbine, liposomal doxorubicin (GVD) in 14-day schedule as salvage regimen for patients with previously heavily treated Hodgkin’s lymphoma and aggressive non-Hodgkin’s lymphoma. Med Oncol 2013, 30, 350–356.
  11. Bartlett NL, Niedzwiecki D, Johnson JL: Gemcytabine, vinorelbine, and pegylated liposomal doxorubicin (GVD), a salvage regimen in relapsed Hodgkin’s lymphoma: CALGB 59804. Ann Oncol 2007, 18, 1071–1091.
  12. Elsamany S, Farooq MU, Elsirafy M, Shamaa S, Sakr M: Phase II study of low-dose fixed-rate infusion of gemcitabine combined with cisplatin and dexamethasone in resistant non-Hodgkin lymphoma and correlation with Bcl-2 and MDR expression. Med Oncol 2014, 31, 872–878.
  13. Cheson BD, Pfistner B, Juweid ME: Revised response criteria for malignant lymphoma. J Clin Oncol 2007, 18, 1071–1079.
  14. Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0 Published: May 28, 2009 (v4.03: June 14, 2010) U.S. Department of Health and Human Services.
  15. Hawkes EA, Barton S, Cunningham D: GEM-P chemotherapy is active in the treatment of relapsed Hodgkin lymphoma. Ann Hematol 2013, 93, 827–834.
  16. El Gnaoui T, Dupuis J, Belhadj K: Rituximab, gemcitabine and oxaliplatin: an effective salvage regimen for patients with relapsed or refractory B-cell lymphoma not candidates for high-dose therapy. Ann Oncol 2007, 18, 1363–1368.
  17. Friedberg JW: New strategies in diffuse large B-cell lymphoma: translating findings from gene expression analyses into clinical practice. Clin Cancer Res 2011, 17, 6112–6117.
  18. Dong M, He XH, Liu P: Gemcitabine-based combination regimen in patients with peripheral T-cell lymphoma. Med Oncol 2013, 30, 351.
  19. Evens AM, Rosen ST, Helenowski I: A phase I/II trial of bortezomib combined concurrently with gemcitabine for relapsed or refractory DLBCL and peripheral T-cell lymphomas. Br J Haematol 2013, 163, 55–61.
  20. Mounier N, El Gnaoui T, Tilly H: Rituximab plus gemcitabine and oxaliplatin in patients with refractory/relapsed diffuse large B-cell lymphoma who are not candidates for high-dose therapy. A phase II lymphoma study association trial. Haematologica 2013, 98, 1726–1731.
  21. Ivanov V, Coso D, Chetaille B: Efficacy and safety of lenalinomide combined with rituximab in patients with relapsed/refractory diffuse large B-cell lymphoma. Leuk Lymphoma 2014, Mar 17 (Epub ahead of print).
  22. Witzing T, Vose J, Zinzani P: An international phase II trial of single-agent lenalidomide for relapsed or refractory aggressive B-cell-non-Hodgkin lymphoma. Ann Oncol 2011, 22, 1622–1627.
  23. Anastasia A, Carlo-Stella C, Corradini P: Bendamustine for Hodgkin lymphoma patients failing autologous or autologous and allogenic stem cell transplantation a retrospective study of Fondazione Italiana Linfomi. Br J Haematol 2014, Mar 7 (Epub ahead of print).
  24. Czyz A, Romejko-Jarosinska J, Knopinska-Posluszny W: Treatment strategy based on gemcitabine-containing salvage chemotherapy used with intent to proceed to second stem cell transplant for patients with Hodgkin lymphoma relapsing after a prior autologous transplant. Leuk Lymphoma 2013, 54, 973–978.
© Wroclaw Medical University