Korean J Intern Med.  2009 Mar;24(1):37-42. 10.3904/kjim.2009.24.1.37.

Gemcitabine, Etoposide, Cisplatin, and Dexamethasone in Patients With Refractory or Relapsed Non-Hodgkin's Lymphoma

• Kim KH
• Joo YD
• Sohn CH
• Shin HJ
• Chung JS
• Cho GJ
• Shin SH
• Kim YS
• Lee WS

• KMID: 1785640
• DOI: http://doi.org/10.3904/kjim.2009.24.1.37

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 mg/m2 by continuous i.v. on days 1 and 8; etoposide 40 mg/m2 by i.v. on days 1-4; cisplatin 60 mg/m2 by i.v. on day 1; or dexamethasone 40 mg 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)x10(6)/kg. 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.

Keyword

Non-Hodgkin's lymphoma; Refractory or relapsed; Gemcitabine

MeSH Terms

Adolescent
Adult
Aged
Antineoplastic Agents/administration & dosage
Antineoplastic Combined Chemotherapy Protocols/*therapeutic use
Biopsy
Cisplatin/administration & dosage
Deoxycytidine/administration & dosage/analogs & derivatives
Dexamethasone/administration & dosage
Etoposide/administration & dosage
Female
Follow-Up Studies
Glucocorticoids/administration & dosage
Humans
Immunosuppressive Agents/administration & dosage
Lymphoma, Large B-Cell, Diffuse/*drug therapy/pathology/surgery
Male
Middle Aged
Neoplasm Recurrence, Local/drug therapy/pathology/surgery
Prospective Studies
Stem Cell Transplantation/methods
Treatment Outcome
Young Adult