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Gemcitabine and vinorelbine combination is effective in both as a salvage and mobilization regimen in relapsed or refractory Hodgkin lymphoma prior to ASCT

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Abstract

We investigated the efficacy of gemcitabine and vinorelbine (Gem/Vin) combination chemotherapy as a salvage and mobilization regimen in relapsed or refractory Hodgkin lymphoma (HL) patients prior to autologous hematopoietic stem cell transplantation. We retrospectively reviewed the data of our relapsed or primary refractory HL patients treated with Gem/Vin regimen which consisted of gemcitabine 1,000 mg/m2/day and vinorelbine 30 mg/m2/day on days 1, 8, and 15 every 28 days. The overall response rate was 72.4%. Ten (34.5%) patients achieved complete remission, 11 (37.9%) partial remission, and eight (27.6%) patients had no response. Mobilization with Gem/Vin regimen was successful in 20/23 (87%) patients while mobilization failure was seen in three (13%) patients. Gemcitabine and vinorelbine is an effective salvage regimen with acceptable toxicity and high mobilization potential in relapsed or refractory HL patients.

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References

  1. Canellos GP, Anderson JR, Propert KJ, Nissen N, Cooper MR, Henderson ES, Green MR, Gottlieb A, Peterson BA (1992) Chemotherapy of advanced Hodgkin’s disease with MOPP, ABVD, or MOPP alternating with ABVD. N Engl J Med 327:1478–1484

    Article  PubMed  CAS  Google Scholar 

  2. Diehl V, Franklin J, Hasenclever D, Tesch H, Pfreundschuh M, Lathan B, Paulus U, Sieber M, Rueffer JU, Sextro M, Engert A, Wolf J, Hermann R, Holmer L, Stappert-Jahn U, Winnerlein-Trump E, Wulf G, Krause S, Glunz A, von Kalle K, Bischoff H, Haedicke C, Duehmke E, Georgii A, Loeffler M (1998) BEACOPP, a new dose-escalated and accelerated regimen, is at least as effective as COPP/ABVD in patients with advanced-stage Hodgkin’s lymphoma: interim report from a trial of the German Hodgkin’s Lymphoma Study Group. J Clin Oncol 16:3810–3821

    PubMed  CAS  Google Scholar 

  3. Canellos GP (2002) Primary treatment of Hodgkin’s disease. Ann Oncol 13(Suppl 4):153–158

    PubMed  Google Scholar 

  4. Küppers R, Yahalom J, Josting A (2006) Advances in biology, diagnostics, and treatment of Hodgkin’s disease. Biol Blood Marrow Transplant 12(1 Suppl 1):66–76

    Article  PubMed  Google Scholar 

  5. Josting A, Engert A, Diehl V, Canellos GP (2002) Prognostic factors and treatment outcome in patients with primary progressive and relapsed Hodgkin’s disease. Ann Oncol 13(Suppl 1):112–116

    PubMed  Google Scholar 

  6. Kuruvilla J (2009) Standard therapy of advanced Hodgkin lymphoma. Hematology Am Soc Hematol Educ Program 497–506

  7. Anderlini P (2002) Hematopoietic stem-cell transplantation for Hodgkin’s disease (HD): current status. Cytotherapy 4:241–251

    Article  PubMed  CAS  Google Scholar 

  8. Yung L, Linch D (2003) Hodgkin’s lymphoma. Lancet 361:943–951

    Article  PubMed  Google Scholar 

  9. Cashen AF, Bartlett NL (2007) Therapy of relapsed Hodgkin lymphoma. Blood Rev 21:233–243

    Article  PubMed  CAS  Google Scholar 

  10. Martín A, Fernández-Jiménez MC, Caballero MD, Canales MA, Pérez-Simón JA, García de Bustos J, Vázquez L, Hernández-Navarro F, San Miguel JF (2001) Long-term follow-up in patients treated with Mini-BEAM as salvage therapy for relapsed or refractory Hodgkin’s disease. Br J Haematol 113:161–171

    Article  PubMed  Google Scholar 

  11. Schmitz N, Pfistner B, Sextro M, Sieber M, Carella AM, Haenel M, Boissevain F, Zschaber R, Müller P, Kirchner H, Lohri A, Decker S, Koch B, Hasenclever D, Goldstone AH, Diehl V, German Hodgkin’s Lymphoma Study Group, Lymphoma Working Party of the European Group for Blood and Marrow Transplantation (2002) Aggressive conventional chemotherapy compared with high-dose chemotherapy with autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkin’s disease: a randomised trial. Lancet 359:2065–2071

    Article  PubMed  CAS  Google Scholar 

  12. Moskowitz CH, Bertino JR, Glassman JR, Hedrick EE, Hunte S, Coady-Lyons N, Agus DB, Goy A, Jurcic J, Noy A, O’Brien J, Portlock CS, Straus DS, Childs B, Frank R, Yahalom J, Filippa D, Louie D, Nimer SD, Zelenetz AD (1999) Ifosfamide, carboplatin, and etoposide: a highly effective cytoreduction and peripheral-blood progenitor-cell mobilization regimen for transplant-eligible patients with non-Hodgkin’s lymphoma. J Clin Oncol 17:3776–3785

    PubMed  CAS  Google Scholar 

  13. Moskowitz CH, Nimer SD, Zelenetz AD, Trippett T, Hedrick EE, Filippa DA, Louie D, Gonzales M, Walits J, Coady-Lyons N, Qin J, Frank R, Bertino JR, Goy A, Noy A, O’Brien JP, Straus D, Portlock CS, Yahalom J (2001) A 2-step comprehensive high-dose chemoradiotherapy second-line program for relapsed and refractory Hodgkin disease: analysis by intent to treat and development of a prognostic model. Blood 97:616–623

    Article  PubMed  CAS  Google Scholar 

  14. Josting A, Rudolph C, Reiser M, Mapara M, Sieber M, Kirchner HH, Dörken B, Hossfeld DK, Diehl V, Engert A, Centers P (2002) Time-intensified dexamethasone/cisplatin/cytarabine: an effective salvage therapy with low toxicity in patients with relapsed and refractory Hodgkin’s disease. Ann Oncol 13:1628–1635

    Article  PubMed  CAS  Google Scholar 

  15. Fermé C, Mounier N, Diviné M, Brice P, Stamatoullas A, Reman O, Voillat L, Jaubert J, Lederlin P, Colin P, Berger F, Salles G (2002) Intensive salvage therapy with high-dose chemotherapy for patients with advanced Hodgkin’s disease in relapse or failure after initial chemotherapy: results of the Groupe d’Etudes des Lymphomes de l’Adulte H89 Trial. J Clin Oncol 20:467–475

    Article  PubMed  Google Scholar 

  16. Oki Y, Younes A (2008) Current role of gemcitabine in the treatment of Hodgkin lymphoma. Leuk Lymphoma 49:883–889

    Article  PubMed  CAS  Google Scholar 

  17. Devizzi L, Santoro A, Bonfante V, Viviani S, Bonadonna G (1996) Vinorelbine: a new promising drug in Hodgkin’s disease. Leuk Lymphoma 22(5–6):409–414

    Article  PubMed  CAS  Google Scholar 

  18. Ozkaynak MF, Jayabose S (2004) Gemcitabine and vinorelbine as a salvage regimen for relapse in Hodgkin lymphoma after autologous hematopoietic stem cell transplantation. Pediatr Hematol Oncol 21:107–113

    Article  PubMed  CAS  Google Scholar 

  19. Spencer A, Reed K, Arthur C (2007) Pilot study of an outpatient-based approach for advanced lymphoma using vinorelbine, gemcitabine and filgrastim. Intern Med J 37:760–766

    PubMed  CAS  Google Scholar 

  20. Bartlett NL, Niedzwiecki D, Johnson JL, Friedberg JW, Johnson KB, van Besien K, Zelenetz AD, Cheson BD, Canellos GP, Cancer Leukemia Group B (2007) Gemcitabine, vinorelbine, and pegylated liposomal doxorubicin (GVD), a salvage regimen in relapsed Hodgkin’s lymphoma: CALGB 59804. Ann Oncol 18:1071–1079, Epub 2007 Apr 10

    Article  PubMed  CAS  Google Scholar 

  21. Santoro A, Magagnoli M, Spina M, Pinotti G, Siracusano L, Michieli M, Nozza A, Sarina B, Morenghi E, Castagna L, Tirelli U, Balzarotti M (2007) Ifosfamide, gemcitabine, and vinorelbine: a new induction regimen for refractory and relapsed Hodgkin’s lymphoma. Haematologica 92:35–41

    Article  PubMed  CAS  Google Scholar 

  22. Magagnoli M, Spina M, Balzarotti M, Timofeeva I, Isa L, Michieli M, Capizzuto R, Morenghi E, Castagna L, Tirelli U, Santoro A (2007) IGEV regimen and a fixed dose of lenograstim: an effective mobilization regimen in pretreated Hodgkin’s lymphoma patients. Bone Marrow Transplant 40:1019–1025, Epub 2007 Oct 1

    Article  PubMed  CAS  Google Scholar 

  23. Lister TA, Crowther D, Sutcliffe SB, Glatstein E, Canellos GP, Young RC, Rosenberg SA, Coltman CA, Tubiana M (1989) Report of a committee convened to discuss the evaluation and staging of patients with Hodgkin’s disease: Cotswolds meeting. J Clin Oncol 7:1630–1636

    PubMed  CAS  Google Scholar 

  24. Hasenclever D, Diehl V (1998) A prognostic score for advanced Hodgkin’s disease. International prognostic factors project on advanced Hodgkin’s disease. N Engl J Med 339:1506–1514

    Article  PubMed  CAS  Google Scholar 

  25. Csoka K, Liliemark J, Larsson R, Nygren P (1995) Evaluation of the cytotoxic activity of gemcitabine in primary cultures of tumor cells from patients with hematologic or solid tumors. Semin Oncol 22(4 Suppl 11):47–53

    PubMed  CAS  Google Scholar 

  26. Venkatesh H, Di Bella N, Flynn TP, Vellek MJ, Boehm KA, Asmar L (2004) Results of a phase II multicenter trial of single-agent gemcitabine in patients with relapsed or chemotherapy-refractory Hodgkin’s lymphoma. Clin Lymphoma 5:110–115

    Article  PubMed  CAS  Google Scholar 

  27. Zinzani PL, Bendandi M, Stefoni V, Albertini P, Gherlinzoni F, Tani M, Piccaluga PP, Tura S (2000) Value of gemcitabine treatment in heavily pretreated Hodgkin’s disease patients. Haematologica 85:926–929

    PubMed  CAS  Google Scholar 

  28. Santoro A, Bredenfeld H, Devizzi L, Tesch H, Bonfante V, Viviani S, Fiedler F, Parra HS, Benoehr C, Pacini M, Bonadonna G, Diehl V (2000) Gemcitabine in the treatment of refractory Hodgkin’s disease: results of a multicenter phase II study. J Clin Oncol 18:2615–2619

    PubMed  CAS  Google Scholar 

  29. Byrne BJ, Gockerman JP (2007) Salvage therapy in Hodgkin’s lymphoma. Oncologist 12:156–167, Review

    Article  PubMed  Google Scholar 

  30. Ng M, Waters J, Cunningham D, Chau I, Horwich A, Hill M, Norman AR, Wotherspoon A, Catovsky D (2005) Gemcitabine, cisplatin and methylprednisolone (GEM-P) is an effective salvage regimen in patients with relapsed and refractory lymphoma. Br J Cancer 92:1352–1357

    Article  PubMed  CAS  Google Scholar 

  31. Chau I, Harries M, Cunningham D, Hill M, Ross PJ, Archer CD, Norman AR, Wotherspoon A, Koh DM, Gill K, Uzzell M, Prior Y, Catovsky D (2003) Gemcitabine, cisplatin and methylprednisolone chemotherapy (GEM-P) is an effective regimen in patients with poor prognostic primary progressive or multiply relapsed Hodgkin’s and non-Hodgkin’s lymphoma. Br J Haematol 120:970–977

    Article  PubMed  CAS  Google Scholar 

  32. Kuruvilla J, Nagy T, Pintilie M, Tsang R, Keating A, Crump M (2006) Similar response rates and superior early progression-free survival with gemcitabine, dexamethasone, and cisplatin salvage therapy compared with carmustine, etoposide, cytarabine, and melphalan salvage therapy prior to autologous stem cell transplantation for recurrent or refractory Hodgkin lymphoma. Cancer 106:353–360

    Article  PubMed  CAS  Google Scholar 

  33. Baetz T, Belch A, Couban S, Imrie K, Yau J, Myers R, Ding K, Paul N, Shepherd L, Iglesias J, Meyer R, Crump M (2003) Gemcitabine, dexamethasone and cisplatin is an active and non-toxic chemotherapy regimen in relapsed or refractory Hodgkin’s disease: a phase II study by the National Cancer Institute of Canada Clinical Trials Group. Ann Oncol 14:1762–1767

    Article  PubMed  CAS  Google Scholar 

  34. Oki Y, Pro B, Fayad LE, Romaguera J, Samaniego F, Hagemeister F, Neelapu S, McLaughlin P, Goy A, Younes A (2008) Phase 2 study of gemcitabine in combination with rituximab in patients with recurrent or refractory Hodgkin lymphoma. Cancer 112:831–836

    Article  PubMed  CAS  Google Scholar 

  35. Mendler JH, Kelly J, Voci S, Marquis D, Rich L, Rossi RM, Bernstein SH, Jordan CT, Liesveld J, Fisher RI, Friedberg JW (2008) Bortezomib and gemcitabine in relapsed or refractory Hodgkin’s lymphoma. Ann Oncol 19:1759–1764, Epub 2008 May 25

    Article  PubMed  CAS  Google Scholar 

  36. Friedberg JW, Neuberg D, Kim H, Miyata S, McCauley M, Fisher DC, Takvorian T, Canellos GP (2003) Gemcitabine added to doxorubicin, bleomycin, and vinblastine for the treatment of de novo Hodgkin disease: unacceptable acute pulmonary toxicity. Cancer 98:978–982

    Article  PubMed  CAS  Google Scholar 

  37. Macann A, Bredenfeld H, Müller RP, Diehl V, Engert A, Eich HT (2008) Radiotherapy does not influence the severe pulmonary toxicity observed with the administration of gemcitabine and bleomycin in patients with advanced-stage Hodgkin’s lymphoma treated with the BAGCOPP regimen: a report by the German Hodgkin’s Lymphoma Study Group. Int J Radiat Oncol Biol Phys 70:161–165

    Article  PubMed  CAS  Google Scholar 

  38. Bonfante V, Viviani S, Santoro A, Devizzi L, Di Russo A, Zanini M, Soncini F, Soto Parra H, Valagussa P, Bonadonna G (1998) Ifosfamide and vinorelbine: an active regimen for patients with relapsed or refractory Hodgkin’s disease. Br J Haematol 103:533–535

    Article  PubMed  CAS  Google Scholar 

  39. Magagnoli M, Sarina B, Balzarotti M, Castagna L, Timofeeva I, Nozza A, Bertuzzi A, Siracusano L, Sinnone M, Santoro A (2001) Mobilizing potential of ifosfamide/vinorelbine-based chemotherapy in pretreated malignant lymphoma. Bone Marrow Transplant 28:923–927

    Article  PubMed  CAS  Google Scholar 

  40. Cole PD, Schwartz CL, Drachtman RA, de Alarcon PA, Chen L, Trippett TM (2009) Phase II study of weekly gemcitabine and vinorelbine for children with recurrent or refractory Hodgkin’s disease: a children’s oncology group report. J Clin Oncol 27:1456–1461, Epub Feb 17

    Article  PubMed  CAS  Google Scholar 

  41. Dasanu CA (2008) Gemcitabine: vascular toxicity and prothrombotic potential. Expert Opin Drug Saf 7:703–716, Review

    Article  PubMed  CAS  Google Scholar 

  42. Lai R, Bartlett NL, Mackey JR, Jung SH, Johnson JL, Cook JR, Jones D, Cass CE, Young JD, Said J, Cheson B, Hsi ED (2008) High expression of nucleoside transporter protein hENT1 in Reed–Sternberg cells is associated with treatment failure in relapsed/refractory Hodgkin lymphoma patients treated with gemcitabine, vinorelbine and liposomal doxorubicin—a CALGB 59804 correlative study. Leuk Lymphoma 49:1202–1205

    Article  PubMed  Google Scholar 

  43. Ozkurt ZN, Yegin ZA, Suyanı E, Akı SZ, Acar K, Yagcı M, Sucak GT (2010) Factors affecting stem cell mobilization for autologous hematopoietic stem cell transplantation. J Clin Apher 25(5):280–286

    Article  PubMed  Google Scholar 

  44. Ng AK, Mauch PM (2009) Late effects of Hodgkin’s disease and its treatment. Cancer J 15:164–168

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Hematology Ankara, Gazi University Faculty of Medicine, Beşevler, 06500, Ankara, Turkey

    Elif Suyanı, Gülsan Türköz Sucak, Şahika Zeynep Akı, Zeynep Arzu Yeğin, Zübeyde Nur Özkurt & Münci Yağcı

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  1. Elif Suyanı
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  2. Gülsan Türköz Sucak
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  3. Şahika Zeynep Akı
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Correspondence to Elif Suyanı.

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Suyanı, E., Sucak, G.T., Akı, Ş.Z. et al. Gemcitabine and vinorelbine combination is effective in both as a salvage and mobilization regimen in relapsed or refractory Hodgkin lymphoma prior to ASCT. Ann Hematol 90, 685–691 (2011). https://doi.org/10.1007/s00277-010-1113-z

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  • DOI: https://doi.org/10.1007/s00277-010-1113-z

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