Gemcitabine, vinorelbine and dexamethasone: A safe and effective regimen for treatment of relapsed/refractory hodgkin's lymphoma. (September 2019)

• Record Type: Journal Article
• Authors: Ganesan, Prasanth; Mehra, Nikita; Joel, Anjana; Radhakrishnan, Venkatraman; Dhanushkodi, Manikandan; Perumal Kalayarasi, Jayachandran; Kannan, Krishnarathinam; Ganesan, Trivadi S; Sagar, Tenali Gnana
• Is Part Of: Leukemia research. Volume 84(2019)
• Publication Date: 2019-09
• Subjects: Relapsed -- Hodgkin's lymphoma -- Salvage -- Adults -- Paediatrics; Leukemia -- Periodicals; Leukemia -- Periodicals; Leucémie -- Périodiques; Leukemia; Periodicals; Electronic journals; Electronic journals; 616.9941905
• DOI: 10.1016/j.leukres.2019.106188
• Languages: English
• ISSNs: 0145-2126

Abstract

Highlights: Multiple salvage chemotherapy options available in R/R HL with varied outcomes. Newer antibodies and immunotherapy regimens are not affordable to many patients. Combination of gemcitabine, vinorelbine and dexamethasone was tried in 48 patients. GVDex demonstrated high efficacy (ORR-64%) and low toxicity. Abstract: Background: Salvage regimens in relapsed/refractory Hodgkin's lymphoma (HL) differ in their efficacy and toxicity profiles. Gemcitabine (G), vinorelbine (V) and liposomal doxorubicin (GVDoxil) is one regimen with high response rates but has high toxicity and cost. We devised a regimen of GVDex by substituting the more expensive liposomal doxorubicin with the cheaper high-dose dexamethasone (Dex). Patients and methods: We analyzed the data of 48 adult and paediatric patients of relapsed/refractory HL who received GVDex as salvage therapy. GVDex was delivered as outpatient once in 3 weeks (Q3 weekly) (G 1000 mg/m 2 IV over 30 min on D1, 8; V 25 mg / m 2 IV fast infusion on D1, 8; Dex40 mg PO D1-4) for 2–3 cycles. We present the overall response rate, toxicity, progression-free (PFS) and overall survival (OS) from the time of start of GVDex. Results: Forty-eight patients [median age: 24 years (5–63)] received GVDex [(median cycles:3(1–6)] in this period. Median time from diagnosis to the first relapse was 18.9 (2–119) months. Overall response rate [ORR = complete (CR)+partial (PR)] was 63%. Eleven (23%) patients developed febrile neutropenia. After a median follow-up of 20 months, the Kaplan-Meier estimates of patients alive and progression-free at 24 months were 60% and 49%, respectively. Conclusions: The response rates with GVDex were comparable to those reported with GVDoxil when used as a first-line salvage regimen in relapsed/refractory HL. It was an effective regimen even in patients who failed 2 lines of therapy for HL.