Ifosfamide, gemcitabine, and vinorelbine: a new induction regimen for refractory and relapsed Hodgkin's lymphoma

Persistence of disease after salvage therapy among relapsed or refractory Hodgkin lymphoma (HL) patients predicts poor outcome. Here, we report on 41 HL patients with active disease after salvage therapy and who received high-dose melphalan (HD-PAM) and auto-SCT as a bridge to a second autologous or an allogeneic transplantation between 2002 and 2013 at our center. Disease response was based on 18-fluoro-deoxyglucose-positron emission tomography results in all patients. Overall response rate after HD-PAM was 78% and it did not differ among PR or stable/progressive disease patients (P = 1.00). Response was associated with better OS: hazard ratio = 0.32 (95% confidence interval: 0.13-0.77, P = 0.01) irrespective of disease status before HD-PAM. Thirtythree patients (80%) were able to complete the planned treatment, intended as tandem autologous or auto-allo transplant. Hematological and extrahematological toxicity of HD-PAM was manageable, without any treatment-related death. In conclusion, HD-PAM is a valuable therapeutic option in relapsed/refractory HL patients with active disease after salvage therapy, with an impressive 78% overall response rate and 80% rate of proceeding to further transplantation. The present data may be integrated with the growing literature on new drugs in the field of relapsed/refractory HL.

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“…15 The number of cycles ranged between two and four. Five patients received other salvage treatments.…”

Section: Salvage Chemotherapymentioning

confidence: 99%

High-dose melphalan with autologous stem cell support in refractory Hodgkin lymphoma patients as a bridge to second transplant

Castagna

Crocchiolo

Giordano

et al. 2015

Bone Marrow Transplant

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“…The rationale for the combination is based on the following: gemcitabine is a cell cycle phase specific pyrimidine analogue structurally similar to cytarabine which inhibits DNA synthesis and induces apoptosis through incorporation of its triphosphate metabolite into DNA whereas cisplatin binds to DNA preventing DNA and RNA synthesis and is phase non-specific. Gemcitabine has shown single agent activity in HD [6] and has been used in combination with non-platinum drugs, for example, the IGEV regimen [7] which consists of 4 cycles (each of ifosfamide with MESNA rescue, vinorelbine , prednisolone and gemcitabine at 800 mg/m 2 for two doses) followed by single or tandem autologous or non-myeloablative allogeneic stem cell transplants if at least a partial response is achieved. Although, despite this aggressive approach, over 3 years freedom from progression is only 53% and 30% of patients die.…”

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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“…In 2007, Santoro et al reported on the use of a regimen of ifosfamide, gemcitabine and vinorelbine (IGEV) for relapsed or refractory HL, prior to HDT/ASCT [17]. Ninety one patients were enrolled in this study, with the majority of patients (76.9%) having received only one previous chemotherapy regimen, and all patients having received previous anthracyclinebased regimens.…”

Section: Editorialmentioning

confidence: 99%

Heads or tails? Choosing a salvage therapy for relapsed/refractory Hodgkin lymphoma

Skarbnik

Pro

2013

Expert Review of Hematology

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Ifosfamide, gemcitabine, and vinorelbine: a new induction regimen for refractory and relapsed Hodgkin's lymphoma

Cited by 214 publications

References 32 publications

High-dose melphalan with autologous stem cell support in refractory Hodgkin lymphoma patients as a bridge to second transplant

High-dose melphalan with autologous stem cell support in refractory Hodgkin lymphoma patients as a bridge to second transplant

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?

Heads or tails? Choosing a salvage therapy for relapsed/refractory Hodgkin lymphoma

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