Efficacy of gemcitabine, cisplatin and methylprednisolone [GEM-P] as a salvage regimen for relapsed and refractory lymphoma

The prognosis of relapsed or refractory aggressive lymphomas after primary therapy remains poor. So, there is a continuous need for development of more effective and less toxic salvage regimens. At present, there is no accepted standard salvage chemotherapy. Gemcitabine is effective in treating lymphoma and, when combined with cisplatin, is effective for some solid tumors. The aim of this study was to evaluate efficacy and safety of gemcitabine with cisplatin and methylprednisolone in patients with relapsed and refractory lymphoma. This study had been carried out on 60 patients with relapsed or refractory aggressive lymphomas between August 2009 and July 2012. All patients were treated with GEM-P regimen [Gemcitabine 1000 mg/m[2] on days 1, 8 and 15, Cisplatin 100 mg/m[2] on day 15, and Methylprednisolone 1000 mg on days 1-5] every 28 days. Response assessment was based on Response Evaluation Criteria in Solid Tumors. Toxicity assessment was scaled according to the Common Terminology Criteria for Adverse Events. The best-achieved response rate or overall response rate [ORR] was 41.7 [95% CI 36. 7-46. 7] with twelve patients [20%] obtaining a CR. The median RFS, PFS, and OS were 16 months [95% CI 6.7-25.2], 6 months [95% CI 4.2-7.7], and 20 months [95% CI 12.4-27.5,], respectively. Toxicity of GEM-P regimen was mainly hematological. The incidence of grade 3 and 4 thrombocytopenia was 30% and 15%, while grade 3 neutropenia developed in 30%. There was no treatment-related death. GEM-P is an effective salvage regimen in patients with relapsed and refractory lymphomas with favorable toxicity profile