Gemcitabine, Dexamethasone, and Cisplatin (GDP) versus Dexamethasone,Cytarabine, and Cisplatin (DHAP) as Salvage Chemotherapy for Patients With Relapsed or Refractory Diffuse Large B-cell Lymphoma (DLBCL)

Abstract

IntroductIonNon Hodgkin lymphomas (NHLs) are the most commonly occurring hematologic malignancies in the United States. They represent 4% to 5% of all new cancer cases. There is 65,540 men and women (35,380 men and 30,160 women) ARM I "cisplatin 75mg/m2 on day 1, dexamethasone 40 mg on days 1-4, and gemcitabine 1000mg/m2 on days 1 and 8, given every 21 days" and ARM II, Patients received "cisplatin 75mg/m2 IV over 24 hours on day 1, dexamethasone as in arm A, and cytarabine 2gm/m2 IV over 3 hours every 12 hours on day 2, given every 21 days". A total of 330 chemotherapy cycles were administered, with a mean of 5.4 cycles per patient (range 2-6). results: Among the sixty two eligible patients treated, there were three early deaths, including one patient in group A and two patient in group B. Four patients in group A and three patients in group B had disease progression during treatment. The overall response rate was 65% (29% CR rate, 38% PR rate) in arm A and 67.6% (32.2% CR rate, 35.4% PR rate) in arm B. The median disease free survival time was 10 months, 9 months (95% CI, 6.078 to 11.922 months), the median Progression free survival time was 4 months (95% CI, 2.108 to 5.892 months), 4 months (95% CI, 3.028 to 4.972 months), the median overall survival time was 20 months (95% CI, 14.377 to 25.623 months), 21 months (95% CI, 9.352 to 32.648 months) for arm A& B, respectively. Hematologic toxicities were comparable between the two arms with greater number of patients developed grade III, IV neutropenia in arm B. The most common grade III or IV hematological toxicities were neutropenia and thrombocytopenia, neutopenia was 62.9% in group A and 70% in group B, febrile neutopenia was significantly higher in group B (53.8%) compared to (22.2%) in group A. Grade III or IV thrombocytopenia was observed in 29.7% among both groups. Other hematological toxicities are comparable in both groups. Stomatitis and infection were higher in arm B. Stomatitis was 36%, 69.2%, Infection was 24%, 42.3% for arm A& B, respectively. conclusion: The study revealed no significant differences between GDP and DHAP as regarding response rate, OS, DFS and PFS in treatment of relapsed or refractory DLBCL. Toxicity was higher in DHAP group.

Definitive salvage chemotherapy for the treatment of refractory/relapsed non-Hodgkin lymphoma, a single center experience

“…Another study done by Ismaeil et al 10 found no significant difference between both regimens after 6 cycles of treatment. They included 62 patients with relapsed or refractory NHL and they observed an ORR of 67.6% in GDP and 65% in DHAP group.…”

“…This correlated with results of Crump et al 9 who found no significant difference between both groups regarding toxicity except for nausea and febrile neutropenia. However, Ismaiel et al 10 found significant difference between both groups in febrile neutropenia, infection and stomatitis.…”