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

Mounier, Nicolas; Gnaoui, Taoufik El; Tilly, Hervé; Canioni, D.; Sebban, Catherine; Casasnovas, Olivier; Delarue, Richard; Sonet, Anne; Beaussart, Pauline; Petrella, Tony; Castaigné, Sylvie; Bologna, Serge; Salles, Gilles; Rahmouni, Alain; Gaulard, Philippe; Haı̈oun, Corinne

doi:10.3324/haematol.2013.090597

Cited by 137 publications

(105 citation statements)

References 22 publications

(29 reference statements)

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“…After four cycles, 44% of the patients achieved CR and 17% achieved PR. The ORR for the whole group of patients was 61% [20]. Gemcitabine in combination with immunotherapy or some immunomodulatory agents could be a key to improving outcomes in aggressive relapsed/refractory NHL.…”

Section: Discussionmentioning

confidence: 96%

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

Rybka¹,

Jurczak²,

Giza³

et al. 2015

Adv Clin Exp Med

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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. Conclusions. The results suggest that gemcitabine-based salvage chemotherapy is effective and well tolerated in patients with relapsed/refractory HL and NHL (Adv Clin Exp Med 2015, 24, 5, 783-789).

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Section: Discussionmentioning

confidence: 96%

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

Rybka¹,

Jurczak²,

Giza³

et al. 2015

Adv Clin Exp Med

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“…Similarly, oxaliplatin, a third generation organoplatinum derivative, has significant cytoxicity towards chemoresistant lymphoma cells and a favorable safety profile. In addition, oxaliplatin has shown mechanistic synergy when combined with gemcitabine in several studies of lymphoma [11,12]. Moreover, pegaspargase displays lower incidence of antiasparaginase antibodies and more prolonged asparaginase activity in comparison with native L-asparaginase [13].…”

Section: Treatment-related Toxicitymentioning

confidence: 99%

Retrospective Study of Pegaspargase, Gemicitabine, Oxaliplatin and Dexamethasone (Peg-GemOD) as a First-Line Therapy for Advanced-Stage Extranodal NK/T Cell Lymphoma

Yao

Tang

Zhuang

et al. 2016

Indian J Hematol Blood Transfus

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This study was conducted to retrospectively investigate the efficacy and safety of pegaspargase, gemicitabine, oxaliplatin and dexamethasone (PegGemOD) combination chemotherapy as a first-line therapy for advanced-stage extranodal NK/T cell lymphoma (ENKTL). Eighteen patients with newly diagnosed stage III/IV ENKTL were subjected to 3-6 cycles of PegGemOD chemotherapy. After 3 cycles of therapy, the overall response rate was 67 % (12/18) with a complete response rate of 28 % (5/18) and a partial response rate of 39 % (7/18). The median overall survival (OS) and progression-free survival (PFS) time were 10 and 8.5 months respectively. For those responders, the median OS and PFS time were significantly better than those of non-responders (median OS, 15 vs. 10 months; P = 0.001 and median PFS, 15 vs. 7 months; P = 0.001). Furthermore, patients with low plasma EBV-DNA levels after induction chemotherapy had a remarkably longer OS and PFS time. The toxicity of Peg-GemOD regimen was acceptable.

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“…The combination of rituximab, gemcitabine, and oxaliplatin (R-GemOx) has been evaluated in transplant-ineligible patients with relapsed or refractory DLBCL and was associated with a favorable overall response rate of 61% and a complete response rate of 44%, with a reasonable toxicity profile. 115 Recently, bendamustine combined with rituximab has demonstrated modest efficacy with an overall response rate of 59% and a median PFS of 7 months. 116 …”

Section: Salvage Therapymentioning

confidence: 99%

Diffuse large B-cell lymphoma: optimizing outcome in the context of clinical and biologic heterogeneity

Sehn

Gascoyne

2015

Blood

459

358

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Although the majority of patients with diffuse large B-cell lymphoma (DLBCL) can be cured with standard rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP), patients who fail R-CHOP have a dismal outcome. Thus, optimization of front-line therapy, as well as the development of more effective salvage strategies, remains an important objective. Advances in molecular genetics have vastly improved our understanding of the biological diversity of DLBCL and have led to the discovery of key oncogenic pathways. In addition to the major molecular designations of germinal center B-cell and activated B-cell subtypes, next-generation sequencing technologies have unveiled the remarkable complexity of DLBCL and identified unique molecular targets that may be differentially exploited for therapeutic benefit. These findings have translated into a growing list of promising novel agents. Moving forward, it is of paramount importance to recognize the heterogeneity of DLBCL and to investigate these targeted agents within patient populations who are most likely to benefit. It will be necessary to prioritize drugs that affect key driver pathways and to combine them rationally to optimize their benefit. Improved prognostication and the availability of predictive biomarkers will be crucial to allow for the possibility of individualized risk-adapted therapy.

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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

Cited by 137 publications

References 22 publications

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

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

Retrospective Study of Pegaspargase, Gemicitabine, Oxaliplatin and Dexamethasone (Peg-GemOD) as a First-Line Therapy for Advanced-Stage Extranodal NK/T Cell Lymphoma

Diffuse large B-cell lymphoma: optimizing outcome in the context of clinical and biologic heterogeneity

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