Skip to main content

Advertisement

SpringerLink
Log in

Study on effectiveness of gemcitabine, dexamethasone, and cisplatin (GDP) for relapsed or refractory AIDS-related non-Hodgkin's lymphoma

  • Original Article
  • Published:
Annals of Hematology Aims and scope Submit manuscript

Abstract

Non-Hodgkin's lymphoma (NHL) remains the second most common malignant complication in patients with human immunodeficiency virus (HIV) infection. Even though NHL is commonly chemosensitive to primary treatment, failure or relapse still occurs in a large number of patients. We conducted this retrospective study to evaluate the efficacy and safety of gemcitabine, dexamethasone, and cisplatin (GDP) for relapsed or refractory AIDS-related NHL (AIDS-NHL). Forty-eight patients with relapsed or refractory AIDS-NHL were treated with intravenous combination chemotherapy with GDP. The overall objective response rate was 54.1 % (95 % confidence interval, CI, 40.1–68.3 %), with 10 complete responses and 16 partial responses. The 2-year overall survival rate (OS) was 70.8 % (95 % CI 58.0–83.7 %), and the 5-year OS was 41.7 % (95 % CI 27.7–55.6 %). The 2-year progression-free survival rate (PFS) was 37.5 % (95 % CI 23.8–51.2 %), and the 5-year PFS was 25.0 % (95 % CI 12.8–37.3 %). The median progression-free survival was 8.8 months (95 % CI 0–20.3 months), and the median overall survival was 40.6 months (95 % CI 22.6–58.6 months). Patients with B cell tumors who relapsed but had no B symptoms were clinical stage I/II, had infiltration fewer than two extranodal sites, had CD4+ counts >200 cells/μL, and had lactate dehydrogenase (LDH) less than the upper limit of normal benefited from GDP. The level of LDH had a significant impact on the response rate to chemotherapy with GDP (P = 0.015). Myelosuppression was the main side effect; the incidence of grade 3–4 anemia was 8.3 %; leukopenia, 37.5 %; and thrombocytopenia, 48.3 %. Univariate and multivariate analyses were performed to determine variables for OS and PFS. This study confirms that GDP is an effective and safe salvage regimen in relapsed or refractory AIDS-NHL, was associated with modest declines in CD4+ lymphocyte counts, and did not promote HIV-1 viral replication.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Goedert JJ (2000) The epidemiology of acquired immunodeficiency syndrome malignancies. Semin Oncol 27:390–401

    PubMed  CAS  Google Scholar 

  2. Kaplan LD, Abrams DI, Feigal E, McGrath M, Kahn J, Neville P et al (1989) AIDS-associated non-Hodgkin's lymphoma in San Francisco. JAMA 261:719–724

    Article  PubMed  CAS  Google Scholar 

  3. Fisher RI, Gaynor ER, Dahlberg S, Oken MM, Grogan TM, Mize EM et al (1993) Comparison of a standard regimen (CHOP) with three intensive chemotherapy regimens for advanced non-Hodgkin's lymphoma. N Engl J Med 328(14):1002–1006

    Article  PubMed  CAS  Google Scholar 

  4. Emmanoulides C, Colovos C, Pinter-Brown L, Hernandez L, Schiller G, Territo M et al (2004) Pilot study of fixed infusion rate gemcitabine with cisplatin and dexamethasone in patients with relapsed or refractory lymphoma. Clin Lymphoma 5:45–49

    Article  Google Scholar 

  5. Baetz T, Belch A, Couban S, Imrie K, Yau J, Myers R et al (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 

  6. Crump M, Baetz T, Couban S, Belch A, Marcellus D, Howson-Jan K et al (2004) Gemcitabine, dexamethasone, and cisplatin in patients with recurrent or refractory aggressive histology B-cell non-Hodgkin lymphoma: a phase II study by the National Cancer Institute of Canada Clinical Trials Group (NCIC-CTG). Cancer 101:1835–1842

    Article  PubMed  CAS  Google Scholar 

  7. Chau I, Harries M, Cunningham D, Hill M, Ross PJ, Archer CD et al (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 

  8. Cheson BD, Horning SJ, Coiffler B, Shipp MA, Fisher RI, Connors JM et al (1999) Report of an international workshop to standardize response criteria for non-Hodgkin's lymphomas. J Clin Oncol 17:1244

    PubMed  CAS  Google Scholar 

  9. Palella FJ, Delaney KM, Moorman AC, Loveless MO, Fuhrer J, Satten GA et al (1998) Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. N Engl J Med 338:853–860

    Article  PubMed  Google Scholar 

  10. Miralles P, Berenguer J, Ribera JM, Rubio R, Mahillo B, Téllez MJ et al (2007) Prognosis of AIDS-related systemic non-Hodgkin lymphoma treated with chemotherapy and highly active antiretroviral therapy depends exclusively on tumor-related factors. J Acquir Immune Defic Syndr 44:167–173

    Article  PubMed  Google Scholar 

  11. Grunewald R, Kanraejan H, Keating MJ, Abbruzzese J, Tarassoff P, Plungett W (1990) Pharmacologically directed design of the dose rate and schedule of 2′, 2′-difluorodeoxycitidine (gemcitabine) administration in leukemia. Cancer Res 50:6823–6826

    PubMed  CAS  Google Scholar 

  12. Fossa A, Santoro A, Hiddemann W, Truemper L, Niederle N, Buksmaui S et al (1999) Gemcitabine as a single agent in the treatment of relapsed or refractory aggressive non-Hodgkin's lymphoma. J Clin Oncol 17:3786–3792

    PubMed  CAS  Google Scholar 

  13. Dumontet C, Morschhauser F, Solal-Celigny P, Bouafia F, Bourgeois E, Thieblemont C et al (2001) Gemcitabine as a single agent in the treatment of relapsed or refractory low-grade non-Hodgkin's lymphoma. Br J Haematol 113:772–778

    Article  PubMed  CAS  Google Scholar 

  14. Zinzani PL, Baliva G, Magagnoli M, Bendandi M, Modugno G, Gherlinzoni F et al (2000) Gemcitabine treatment in pretreated cutaneous T-cell lymphoma: experience in 44 patients. J Clin Oncol 18:2603–2606

    PubMed  CAS  Google Scholar 

  15. Peters GJ, Ruiz van Haperen VW, Bergman AM, Veerman G, Smitskamp-Wilms E, van Moorsel CJ et al (1996) Preclinical combination therapy with gemcitabine and mechanisms of resistance. Semin Oncol 23:16–24

    PubMed  CAS  Google Scholar 

  16. Little RF, Pittaluga S, Grant N, Steinberg SM, Kavlick MF, Mitsuya H et al (2003) Highly effective treatment of acquired immunodeficiency syndrome-related lymphoma with dose-adjusted EPOCH: impact of antiretroviral therapy suspension and tumor biology. Blood 101:4653–4659

    Article  PubMed  CAS  Google Scholar 

  17. Ratner L, Lee J, Tang S, Redden D, Hamzeh F, Herndier B et al (2001) Chemotherapy for human immunodeficiency virus-associated non-Hodgkin's lymphoma in combination with highly active antiretroviral therapy. J Clin Oncol 19:2171–2178

    PubMed  CAS  Google Scholar 

Download references

Acknowledgments

We thank the following for their assistance: the patients who volunteered for this study and all the staff of Fujian Medical University Tumor Research Center who contributed to this study. We also wish to thanks Mr. Cai Dingnan for his assistance in statistical analysis.

Conflict of interest

The authors declare no potential conflicts of interest with respect to the authorship and/or publication of this article.

Author information

Authors and Affiliations

  1. Department of Medical Oncology, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian, People’s Republic of China

    Dong Ta Zhong, Chun Mei Shi & Qiang Chen

  2. Fujian Key Laboratory of Translational Cancer Medicine, Fuzhou, 350001, Fujian, People’s Republic of China

    Dong Ta Zhong, Chun Mei Shi & Qiang Chen

  3. Department of Medicine, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, People’s Republic of China

    Jing Ze Huang

  4. Department of Pathology, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, People’s Republic of China

    Jian Gang Liang

Authors
  1. Dong Ta Zhong
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chun Mei Shi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Qiang Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jing Ze Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jian Gang Liang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Qiang Chen.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zhong, D.T., Shi, C.M., Chen, Q. et al. Study on effectiveness of gemcitabine, dexamethasone, and cisplatin (GDP) for relapsed or refractory AIDS-related non-Hodgkin's lymphoma. Ann Hematol 91, 1757–1763 (2012). https://doi.org/10.1007/s00277-012-1518-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00277-012-1518-y

Keywords

Search

Navigation