Gemcitabine Plus Vinorelbine for Refractory or Relapsing Non-Hodgkin Lymphoma: Response Rate and Survival

Abstract

Background: Two chemotherapeutic agents, vinorelbine and gemcitabine, have shown encouraging early results in the treatment of heavily pre-treated relapsed or refractory lymphoma when used as single agents, with responses of between 20 and 47%. This work aimed to evaluate the role of gemcitabine and vinorelbine in the treatment of relapsed and /or refractory aggressive Non-Hodgkin Lymphoma (NHL) as regard response rate, survival analysis. Methods: This prospective study was conducted on 20 patients who had relapsed and /or refractory NHL and treated with a minimum follow of 6 months. All patients were subjected to full clinical examination, laboratory and radiological study. Vinorelbine, Gemcitabine, dexamethasone, filgrastim (VGF) was administrated, On days 1 and 8, patients received vinorelbine 25 mg/m2, Gemcitabine 1000 mg/m2 and Dexamethasone 16mg/m2 I.V, On day 9, they received peg-filgrastim 6 mg subcutaneously, Patients received 4 cycles of VGF, Assessment was performed after 4th cycle of treatment and according to response during follow up period, the patient received 2 more cycles with minimum follow up 6 months and/or PET-CT was done in all patients to evaluate response rate. Results: Regarding status; 60 % of patients were relapsed and 40% of them were refractory. Regarding line therapy: all patients were treated with 1st line protocol of Rituxan/Rituximab-Cyclophosphamide-Hydroxydaunorubicin-Oncovin-Prednisone regimen (R-CHOP), and 4 of them had been treated with 2nd line chemotherapy of Ifosfamide, Cisplatin or Carboplatin, and Etoposide (ICE). So 80% of patients received VGF chemotherapy as 2nd line, while 20% of them received it as the 3rd line. And there was no statistical difference between relapsed and refractory groups regarding lines of VGF chemotherapy. Regarding the toxicity of VGF (toxicity criteria as defined by Chesson and WHO); 50% of patients complicated with grade III anaemia, 50% of patients complicated with grade III neutropenia, 60% of patients complicated with grade III thrombocytopenia, 20% of patients complicated with grade II GIT upset, 40% of patients complicated grade II thrombophlebitis and 40% of patients complicated with grade II neurotoxicity. Conclusions: VGF shows substantial activity in relapsed or refractory aggressive NHL. The regimen is generally well-tolerated, but haematological toxicity is common.