Gemcitabine, Etoposide, Cisplatin, and Dexamethasone in Patients With Refractory or Relapsed Non-Hodgkin’s Lymphoma
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Background/Aims: To date, an effective salvage chemotherapy regimen for the treatment of refractory or relapsing non-Hodgkin’s lymphoma (NHL) has not been discovered. This study was conducted to evaluate the efficacy and safety of gemcitabine, etoposide, cisplatin, and dexamethasone in relapsed or refractory NHL patients. Methods: All patients had histologically proven relapsed or refractory NHL. Treatments consisted of gemcitabine 700 ㎎/㎡ by continuous i.v. on days 1 and 8; etoposide 40 ㎎/㎡ by i.v. on days 1-4; cisplatin 60 ㎎/㎡ by i.v. on day 1; or dexamethasone 40 ㎎ by i.v. on days 1-4 (GEPD) every 21 days. The primary end point was the patient response rate following two cycles of treatment. After two cycles, stem cells were harvested using mobilizing regimens (ESHAP or GEPD plus filgrastim), and this was followed by autologous stem cell transplantation or four additional cycles of GEPD. Results: Between January 2005 and January 2006, 20 patients (13 males and 7 females) were enrolled in the study. The median age was 53 (range 16-75) years. The most common histology was diffuse large B-cell lymphoma (n=10). The median follow-up duration was 5.2 (range 1.0-16.0) months. After two cycles, the overall response rate was 50.0% (10/20), including two complete responses and eight partial responses. The doselimiting toxicity was myelosuppression. Grade Ⅳ neutropenia and thrombocytopenia occurred in 13 (65.0%) and 6 patients (30.0%), respectively. The median number of CD34-positive cells collected was 6.0 (range, 2.8-11.6) ×106/㎏. Of the 17 patients < 66 years of age, 4 (23.5%) proceeded to autologous stem cell transplantation. Conclusions: GEPD chemotherapy in patients with refractory or relapsed NHL was effective as a salvage therapy and helpful for stem cell harvest followed by autologous transplantation.
Abstract
Background/Aims: To date, an effective salvage chemotherapy regimen for the treatment of refractory or relapsing non-Hodgkin’s lymphoma (NHL) has not been discovered. This study was conducted to evaluate the efficacy and safety of gemcitabine, etoposide, cisplatin, and dexamethasone in relapsed or refractory NHL patients. Methods: All patients had histologically proven relapsed or refractory NHL. Treatments consisted of gemcitabine 700 ㎎/㎡ by continuous i.v. on days 1 and 8; etoposide 40 ㎎/㎡ by i.v. on days 1-4; cisplatin 60 ㎎/㎡ by i.v. on day 1; or dexamethasone 40 ㎎ by i.v. on days 1-4 (GEPD) every 21 days. The primary end point was the patient response rate following two cycles of treatment. After two cycles, stem cells were harvested using mobilizing regimens (ESHAP or GEPD plus filgrastim), and this was followed by autologous stem cell transplantation or four additional cycles of GEPD. Results: Between January 2005 and January 2006, 20 patients (13 males and 7 females) were enrolled in the study. The median age was 53 (range 16-75) years. The most common histology was diffuse large B-cell lymphoma (n=10). The median follow-up duration was 5.2 (range 1.0-16.0) months. After two cycles, the overall response rate was 50.0% (10/20), including two complete responses and eight partial responses. The doselimiting toxicity was myelosuppression. Grade Ⅳ neutropenia and thrombocytopenia occurred in 13 (65.0%) and 6 patients (30.0%), respectively. The median number of CD34-positive cells collected was 6.0 (range, 2.8-11.6) ×106/㎏. Of the 17 patients < 66 years of age, 4 (23.5%) proceeded to autologous stem cell transplantation. Conclusions: GEPD chemotherapy in patients with refractory or relapsed NHL was effective as a salvage therapy and helpful for stem cell harvest followed by autologous transplantation.
참고문헌 (22)
- Hickish T, "EPIC: an effective low toxicity regimen for relapsing lymphoma", Br J Cancer, 68, pp.599~604 (1993)
- Sweetenham JW, "ESHAP chemotherapy for relapsed", refractory non-Hodgkin’s lymphoma, 1994, pp.12, 2766a~
- Bernell P, "Promising activity of gemcitabine in refractory high-grade non-Hodgkin’s lymphoma", Br J Haematol, 101, pp.203~204 (1998)
- Fossa A, "Gemcitabine as a single agent in the treatment of relapsed or refractory aggressive non-Hodgkin’s lymphoma", J Clin Oncol, 17, pp.3786~3792 (1999)
- Sallah S, "Treatment of refractory T-cell malignancies using gemcitabine", Br J Haematol, 113, pp.185~187 (2001)
- Santoro A, "Gemcitabine in the treatment of refractory Hodgkin’s disease: results of a multicenter phase II study", J Clin Oncol, 18, pp.2615~2619 (2000)
- Savage DG, "Gemcitabine for relapsed or resistant lymphoma", Ann Oncol, 11, pp.595~597 (2000)
- Zinzani PL, "Value of gemcitabine treatment in heavily pretreated Hodgkin’s disease patients", Haematologica, 85, pp.926~929 (2000)
- Chau I, "Gemcitabine, cisplatin and methylprednisolone chemotherapy (GEM-P) is an effective regimen in patients with poor prognostic primary progressive or multiply repalsed Hodgkin’s and non-Hodgkin’s lymphoma", Br J Haematol, 120, pp.970~977 (2003)
- Jaffe ES, "World Health Organization classification of tumors, pathology and genetics of tumors of hematopoietic and lymphoid tissues" (2001), IARC Press
- Cheson BD, "Report of an international workshop to standardize response criteria for non-Hodgkin’s lymphomas", J Clin Oncol, 17, pp.1244~ (1999)
- Storniolo AM, "Preclinical, pharmacologic and phase I studies of gemcitabine", Semin Oncol, 24, pp.2~7 (1997)
- Grunewald R, "Pharmacologically directed design of the dose rate and schedule of 2’,2’-difluorodeoxycitidine (gemcitabine) administration in- leukemia", Cancer Res, 50, pp.6823~6826 (1990)
- Velaquez WS, "Effective salvage therapy for lymphoma with cisplatin in combination with highdose Ara-C and dexamethasone (DHAP)", Blood, 71, pp.117~122 (1988)
- Crump M, "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, 101, pp.1835~1842 (2004)
- ChulWonChoi, "ESHAP Salvage Therapy for Relapsed or Refractory Non-Hodgkin's Lymphoma", Journal of Korean Medical Science, 17(5), pp.621~624 (2002), 대한의학회
- Dumontet C, "Gemcitabine as a single agent in the treatment of relapsed or refractory lowgrade non-Hodgkin’s lymphoma", Br J Haematol, 13, pp.772~778 (2001)
- Kroep JR, "Gemcitabinecisplatin: a schedule finding study", Ann Oncol, 10, pp.1503~1510 (1999)
- van Moorsel CJ, "Pharmacokinetic schedule finding study of the combination of gemcitabine and cisplatin in patients with solid tumors", Ann Oncol, 10, pp.441~448 (1999)
- Nagourney RA, "Gemcitabine plus cisplatin repeating doublet therapy in previously treated, relapsed breast cancer patients", J Clin Oncol, 18, pp.2245~2249 (2000)
- Peters GJ, "Interaction between cisplatin and gemcitabine in vitro and in vivo", Semin Oncol, 22(4), pp.72~79 (1995)
- Zinzani PL, "Gemcitabine treatment in pretreated cutaneous T-cell lymphoma: experience in 44 patients", J Clin Oncol, 18, pp.2603~2606 (2008)