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?

Abstract

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.

The Role of Autologous Transplantation in Hodgkin Lymphoma

“…Several authors have listed historical comparisons of different salvage regimens [21,24,27]. New salvage concepts are being developed [24,25], such as risk-adapted salvage therapy [26] or no treatment delay in case of cytopenia [25], but tumor control has not been convincingly improved. Thus, the question of the optimal salvage concept still remains to be answered.…”

“…A plethora of studies have been performed with different conventional salvage regimens before the administration of HDCT (Table 1) [22][23][24][25][26]. Although response rates (RRs), toxicity profiles, and stem cell mobilization rates of salvage chemotherapy were different, detailed analyses comparing various regimens are difficult because of the small number of patients and the heterogeneous patient population, including patients with primary progressive or relapsed disease.…”

Linfoma de Hodgkin con compromiso hepático tratado con esquema gemcitabina, dexametasona y cisplatino como puente para terapia estándar: Caso clínico

“…El esquema GDP ha sido usado en LH refractarios a tratamiento 8,9 . En una serie de 17 pacientes se encontró una respuesta global de 94% y completa de 65%, principalmente en el grupo que recibió 3 ciclos 12 .…”

“…La terapia con esquema ABVD (doxorrubicina, bleomicina, vinblastina y dacarbazina) podría agregar un factor adicional de toxicidad hepática en este caso, lo que plantea un dilema en el tratamiento inicial de estos pacientes 5 . A continuación se presenta el caso de una paciente portadora de un linfoma Hodgkin con compromiso hepático, que es tratada con el esquema GDP (gemcitabina, dexametasona, cisplatino), el cual posee menos hepatotoxicidad 1,[5][6][7] , se puede utilizar a dosis plenas 1 y ha mostrado efectividad en esta patología [7][8][9] .…”