Gemcitabine, cisplatin and methylprednisolone (GEM-P) is an effective salvage regimen in patients with relapsed and refractory lymphoma

Ng, M.; Waters, Justin S.; Cunningham, David; Chau, Ian; Horwich, A.; Hill, Mark; Norman, A.; Wotherspoon, Andrew; Catovsky, Daniel

doi:10.1038/sj.bjc.6602514

Cited by 48 publications

(27 citation statements)

References 47 publications

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“…The statistical design of the study was based on the two-stage Simon's minimax model [15]. The sample size of 24 patients was based on alpha=0.05, beta=0.20, p0=0.3, and p1=0.7.…”

Section: Discussionmentioning

confidence: 99%

Salvage chemotherapy of gemcitabine, dexamethasone, and cisplatin (GDP) for patients with relapsed or refractory peripheral T-cell lymphomas: a consortium for improving survival of lymphoma (CISL) trial

et al. 2015

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There is no standard salvage chemotherapy for relapsed or refractory peripheral T-cell lymphomas (PTCLs). Gemcitabine combined with cisplatin has been known as an effective regimen for lymphoma treatment in the salvage setting. We investigated the efficacy and toxicity of gemcitabine, dexamethasone, and cisplatin (GDP) for relapsed or refractory PTCLs in search of a more effective and less toxic therapy. Patients with relapsed or refractory PTCLs with more than one previous regimen were eligible. Treatment consisted of gemcitabine 1000 mg/m(2) intravenously (i.v.) on days 1 and 8, dexamethasone 40 mg orally on days 1-4, and cisplatin 70 mg/m(2) i.v. on day 1, and then every 21 days. Patients could proceed to autologous stem cell transplantation (ASCT) after four cycles of GDP or receive up to six treatment cycles. Twenty-five eligible patients were evaluated for toxicity and response. The diagnoses of participants included 14 cases of PTCL-not otherwise specified (NOS) (56 %) and four cases of angioimmunoblastic T-cell lymphoma (16 %) among others. The median age of the patients was 59 years (range 20-75 years). After treatments with GDP, which delivered a median of four GDP cycles, there were 12 patients with complete responses (CR; 48 %) and six with partial responses (PR; 24 %). The overall response rate (RR) was 72 %. Four patients preceded to ASCT, and three patients finally achieved CR. The median progression free survival was 9.3 months (95 % confidence interval (CI); 4.1-14.6) with a median follow-up duration of 27.1 months. In a total of 86 cycles of GDP, grade 3 or 4 neutropenia and thrombocytopenia occurred in 16.3 and 12.8 % of cycles, respectively. Three patients (3.3 %) experienced febrile neutropenia. GDP is a highly effective and optimal salvage regimen for relapsed or refractory PTCLs and can be administered with acceptable toxicity.

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“…The statistical design of the study was based on the two-stage Simon's minimax model [15]. The sample size of 24 patients was based on alpha=0.05, beta=0.20, p0=0.3, and p1=0.7.…”

Section: Discussionmentioning

confidence: 99%

Salvage chemotherapy of gemcitabine, dexamethasone, and cisplatin (GDP) for patients with relapsed or refractory peripheral T-cell lymphomas: a consortium for improving survival of lymphoma (CISL) trial

et al. 2015

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“…The toxicity of these regimes is mainly hematological and they generally allow for the adequate collection of PbSC in the majority of patients. The second group is formed by the gemcitabinecontaining regimens, frequently associated with vinorelbine and/or platinum compounds (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29). These regimens produce complete remission rates ranging from 21 to 43%, and are generally less toxic to bone marrow.…”

Section: Discussionmentioning

confidence: 99%

Role of conventional salvage multiple-drug chemotherapy in relapsed and refractory aggressive non-Hodgkin lymphomas

et al. 2010

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Abstract. Autologous stem cell transplantation is the standard care for patients with relapsed or refractory aggressive nonHodgkin lymphomas. Of the patients who are sensitive to second-line chemotherapy, approximately 40-50% are likely to be cured using this approach. The optimal salvage regimen for pre-transplant debulking is controversial and these second-line chemotherapies are particularly important for patients who cannot undergo transplantation for various reasons including age, comorbidity and insufficient stem cell collection. Numerous reports regarding this topic are available. This study evaluated reports published in the last 5 years, focusing on conventional multiple-drug second-line chemotherapies (with or without rituximab), and disregarding single-agent investigational phase-II trials. Results are encouraging, particularly when considering that the more recent and less toxic combinations appear to be equivalent to or even more favourable than previous, more aggressive approaches. Previous results obtained using a combination of mitoxantrone, carboplatin, cytarabine and methylprednisolone, are further updated and included in this study. In conclusion, the most effective conventional chemotherapy currently available for patients with relapsed or refractory nonHodgkin lymphomas obtains complete remission rates of up to 50-70%; the achievement of a complete remission is the most important factor associated with a better outcome. Although the addition of rituximab is beneficial and safe, it is more effective in patients who have previously not been exposed to this monoclonal antibody. The addition of cycles of salvage chemotherapy to those strictly required for mobilization of peripheral blood stem cells ultimately improves the response rate.

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“…Although, despite this aggressive approach, over 3 years freedom from progression is only 53% and 30% of patients die. Gemcitabine and cisplatin in combination have shown effectiveness in solid tumours, non-Hodgkin's lymphoma (NHL) and, in two small patient series, in relapsed or refractory Hodgkin lymphoma [8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

“…The second series [9][10][11] used gemcitabine 1,000 mg/m 2 IV on days 1, 8 and 15, methylprednisolone 1,000 mg orally or IV days 1-5 and cisplatin 100 mg/m 2 IV on day 15 (GEM-P). This outpatient regimen was repeated every 28 days for 1 to 6 cycles.…”

Section: Introductionmentioning

confidence: 99%

Intermediate dose gemcitabine–cisplatin combination chemotherapy without treatment delay for cytopenia followed by autografting—a new standard of care in relapsed or refractory Hodgkin lymphoma?

Todd

Raj²,

Camilleri³

et al. 2009

Ann Hematol

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Ten percent to 20% of patients with Hodgkin Lymphoma (HL) are refractory to first-line therapy or relapse. Existing salvage regimens have response rates of 60-85%, considerable toxicity and frequent treatment delay or dose reduction. We report a gemcitabine, cisplatin, and dexamethasone regimen (GemCis) with intensive growth factor and platelet support and no treatment delay. Seventeen patients with relapsed or refractory biopsy proven HL were treated. Toxicity, transfusion requirement, stem cell harvesting and engraftment data were collected. Response assessment was by computed tomography and positron emission tomography. Overall and complete response rates were high (94% and 65%, respectively). There were no episodes of febrile neutropenia, treatment delays or hospital admissions. All 15 patients intended for autograft were successfully harvested. All engrafted successfully with a median time for the entire group to neutrophil engraftment of 14 days. With a median followup of 22 months, the median survival has not yet been reached, and the estimated 2-year survival is 88%. GemCis is a well-tolerated outpatient regimen for relapsed/ refractory Hodgkin lymphoma which does not inhibit stem cell mobilisation, gives excellent response rates and compares favourably with previously published salvage regimens using these or other chemotherapy agents.

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Gemcitabine, cisplatin and methylprednisolone (GEM-P) is an effective salvage regimen in patients with relapsed and refractory lymphoma

Cited by 48 publications

References 47 publications

Salvage chemotherapy of gemcitabine, dexamethasone, and cisplatin (GDP) for patients with relapsed or refractory peripheral T-cell lymphomas: a consortium for improving survival of lymphoma (CISL) trial

Salvage chemotherapy of gemcitabine, dexamethasone, and cisplatin (GDP) for patients with relapsed or refractory peripheral T-cell lymphomas: a consortium for improving survival of lymphoma (CISL) trial

Role of conventional salvage multiple-drug chemotherapy in relapsed and refractory aggressive non-Hodgkin lymphomas

Intermediate dose gemcitabine–cisplatin combination chemotherapy without treatment delay for cytopenia followed by autografting—a new standard of care in relapsed or refractory Hodgkin lymphoma?

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