Gemcitabina e ifosfamida no tratamento do linfoma de Hodgkin refratário ou recidivado após múltiplas terapias: [carta ao editor] / Gemcitabine and ifosfamide in the treatment of Hodgkin's lymphoma refractory to or relapsed after multiple therapies: [letter to the editor]

ABSTRACT

Patients with Hodgkin's lymphoma relapsed after or refractory to multiple therapies (rHL) have a dismal prognosis. Monotherapy with gemcitabine can promote an overall response rate of about 40 percent in these patients and its association with alkylating agents can provide better results. We retrospectively evaluated 17 rHL cases. All were treated with the combination of gemcitabine (1.0 g/m²; D1 and D8) and ifosfamide (1.0 g/m²; D1 to D5) in a 21-day cycle. Treatment response was evaluated according to the Cotswolds criteria. Toxicity was evaluated according to WHO criteria. The median age of all patients was 34 years (18-53). Nine of them (53 percent) were men and eight (47 percent) had Stage III/IV. The median number of previous treatments was 2 (2-3); two patients had already been treated with autologous stem cell transplant. Overall response rate to the combined regimen was 62.5 percent (95 percent CI = 38.8 percent - 86.2 percent) and the median progression-free survival was 15 months (95 percent CI = 4 - 24 months). Fifty-six cycles were evaluated for toxicity. The most frequent toxicities observed by cycle were: hepatic Grade I/II in 48.2 percent of the cycles and Grade III/IV in 1.8 percent; anemia Grade I/II in 45 percent; neutropenia Grade I/II in 36 percent and Grade III/IV 16 percent. Grade III/IV renal toxicity on any degree of haematuria were not observed. Combined therapy with Gemcitabine and Ifosfamide promoted responses in more than half of the evaluated patients with an acceptable toxicity profile.