Rituximab, Gemcitabine, Cisplatin and Methylprednisolone (R-GEM-P) is an effective regimen in relapsed diffuse large B-cell lymphoma.
BACKGROUND
Patients with relapsed diffuse large B-cell lymphoma (DLBCL) have a poor prognosis. Gemcitabine, methylprednisolone, cisplatin +/- rituximab (GEM-P+/-R) is a salvage regimen with limited overlap in toxicity with first-line therapy and short duration of inpatient delivery.


METHODS
We assessed the efficacy and safety of GEM-P+/-R in a retrospective single-centre analysis including patients meeting criteria of ≥ 18 yr of age, histologically proven DLBCL, treated between 2001 and 2011 in second-line with gemcitabine 1000 mg/m(2) day 1, 8 and 15, methylprednisolone 1000 mg day 1-5, cisplatin 100 mg/m(2) day 15 (replaced with carboplatin AUC5 if contraindication/toxicity) +/- rituximab 375 mg/m(2) day 1 and 15, every 28 d.


RESULTS
Forty-five patients aged 25-74 received a median of three cycles of GEM-P+/-R; 64% received rituximab. In 44 evaluable patients receiving GEM-P+/-R, overall response rate (ORR) was 48%; in 28 evaluable patients treated with rituximab + GEM-P (R-GEM-P), ORR was 61%. With median follow-up of 50.5 months (95% CI: 28.3-72.7), 3-yr overall survival (OS) from start of GEM-P+/-R was 31.4% (95% CI: 16.5-46.3); in patients treated with R-GEM-P, 3-yr OS was 49.1% (95% CI: 28.7-69.5). Predominant grade ≥ 3 toxicities were haematological; thrombocytopenia 69%, neutropenia 60% and febrile neutropenia 7%.


CONCLUSION
R-GEM-P is a deliverable regimen with useful activity in second-line treatment of DLBCL. Our data suggest that rituximab should be given concurrently.
['Barton|Sarah|S|', 'Hawkes|Eliza A|EA|', 'Cunningham|David|D|', 'Peckitt|Clare|C|', 'Chua|Sue|S|', 'Wotherspoon|Andrew|A|', 'Attygalle|Ayoma|A|', 'Horwich|Alan|A|', 'Potter|Mike|M|', 'Ethell|Mark|M|', 'Dearden|Claire|C|', 'Gleeson|Mary|M|', 'Chau|Ian|I|']
D000328:Adult D000368:Aged D058846:Antibodies, Monoclonal, Murine-Derived D000971:Antineoplastic Combined Chemotherapy Protocols D016190:Carboplatin D002945:Cisplatin D003841:Deoxycytidine D004334:Drug Administration Schedule D057915:Drug Substitution D005260:Female D005500:Follow-Up Studies D006801:Humans D016403:Lymphoma, Large B-Cell, Diffuse D008297:Male D008775:Methylprednisolone D008875:Middle Aged D009503:Neutropenia D012008:Recurrence D012189:Retrospective Studies D000069283:Rituximab D016879:Salvage Therapy D016019:Survival Analysis D013921:Thrombocytopenia D016896:Treatment Outcome
rituximab gemcitabine cisplatin relapse diffuse large B-cell lymphoma