Long-Term Outcome of Gemcitabine, Vinorelbine, Liposomal-Doxorubicin (GVD) As Salvage Regimen for Patients with Previously Heavily Treated Hodgkin Lymphoma and Aggressive Non-Hodgkin Lymphoma
Authors: Huang Hui-qiang , Bai Bing , Cai Qingqing , Lin Xu-Bin , Wang Xiao-Xiao , Cai Qi-Chun 
Published: October 2019

Abstract
Abstract 1609

Introduction:
Salvage chemotherapy followed by autologous stem cell transplant (ASCT) remains to be the standard treatment for most patients with relapsed and refractory aggressive non- Hodgkin lymphoma(NHL) and Hodgkin lymphoma(HL). However, there are no standard salvage chemotherapy regimens for these patients especially for refractory patients. The combination of gemcitabine, vinorelbine and liposomal-doxorubicin (GVD regimen) had been reported to be effective in patients with relapsed HL (N.L.Bartlett et al. Ann Oncol. 2007).The overall response rate was 70% and the complete remission rate was 19%. The main toxicities were mucositis (23%) and febrile neutropenia (9%). Despite this encouraging result in relapsed HL, it was still unclear whether GVD regimen was effective in recurrent aggressive NHL.

Objective:
This study aimed to evaluate the efficacy and toxicity of GVD regimen in patients with refractory aggressive NHL and HL.

Patients and methods:
Patients with aggressive NHL and HL who were relapsed or refractory to at least one salvage chemotherapy regimen were enrolled. The GVD regimen was given as follows: gemcitabine: 1000 mg/m2 intravenous(i.v.)on day 1,vinorelbine: 15 mg/m2 i.v. on day 1≤⪢liposomal-doxorubicin: 25 mg/m2 i.v. on day 1, repeated for 14 days≤®Patients with complete response (CR)or partial response (PR) proceeded to autologous stem cell transplant (ASCT) as consolidation.

Results:
From 1 May 2006 to 30 August 2008, 35 patients (25 NHL and 10 HL) were enrolled and received 129 cycles of chemotherapy. Twenty patients (57.1%) had been treated with at least 3 chemotherapy regimens before enrollment, and 15 patients (42.9%) had been treated with 2 chemotherapy regimens before. The overall response rate (ORR)was 48.6%(95% CI: 32.0%∼65.1%), with 31.4% CR rate(95%CI: 16.0%∼46.8%)≤®The ORR was higher in patients with HL than in patients with NHL(80.0% vs. 36.0%,p=0.023). The ORR was higher in relapsed patients than in refractory patients(73.3% vs. 30.0%,p=0.013). Sixteen patients (9 NHL and 7 HL) were treated by high dose chemotherapy supported by ASCT. With median follow-up of 16 months (2∼61 months),the median progression free survival(PFS) was 5 months(1∼61 months) and the median survival time was 38 months (2∼61 months). 4-year PFS and 4-year overall survival was 28.1% and 58.2% respectively. The serum LDH level and the sequential ASCT were independent prognostic factors. The survival time in patients treated with subsequent ASCT was significantly longer than those without ASCT (median survival: not reached vs. 21 months, p=0.005). The major toxicity was myelosuppression. The incidence of grade ¢ó/¢ô neutropenia and thrombocytopenia was 34.3% and 5.7% respectively≤®Mobilization of hematopoietic progenitor cell was successful in all the 16 patients. There were no treatment-related deaths.

Conclusion:
GVD regimen is an effective and well-tolerated salvage regimen both for patients with HL and patients with aggressive NHL. GVD followed by AHST yields promising long-lime survival even in patients who are previously heavily treated.

Disclosures:
No relevant conflicts of interest to declare.