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Original Article

Prognostic factors and efficacy of GDP-R therapy in refractory/relapsed
diffuse large B-cell lymphomas not eligible for high-dose therapy

Francesco Ghio , Giulia Cervetti , Nadia Cecconi , Matteo Pelosini , Sara Galimberti , Riccardo Morganti ,
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Paola Ferrari , Andrea Nicolini , Mario Petrini 1
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1 Department of Clinical and Experimental Medicine, University of Pisa, 67-56127 Pisa, Italy.
2 Department of Oncology, University Hospital of Pisa, 67-56127 Pisa, Italy.
Correspondence to: Dr. Francesco Ghio, Department of Clinical and Experimental Medicine, University of Pisa, 67-56127 Pisa, Italy.
E-mail: francescoghio83@gmail.com
A B S T R AC T
Aim: The main aim of the present study was to evaluate the overall survival (OS) and time to treatment failure (TTF) in a cohort of
relapsed/refractory diffuse large B-cell lymphomas (DLBCLs) not eligible for high-dose therapy (HDT) treated with gemcitabine
in association with dexamethasone, cisplatin and rituximab (GDP-R) protocol. The secondary aim was to identify the prognostic
factors impacting OS and TTF. Methods: The authors retrospectively analyzed 45 patients with refractory/relapsed DLBCLs
treated with GDP-R. Results: Overall response rate (ORR) was 48.8%; complete response 15/45 (33.3%), partial response 7/45
(15.5%). Response was influenced by the number of previous therapies administered and International Prognostic Index (IPI)
value. Although no significant impact occurred with regard to OS, patients pre-treated with 2 or < 2 chemotherapeutic regimens
had better ORR (P = 0.014) and a longer TTF (P = 0.029 in multivariate Cox model). IPI value also influenced TTF. Patients with <
2 IPI value had significantly more prolonged TTF than the other ones (P = 0.048 in multivariate Cox model). Treatment was well-
tolerated, with the majority of patients treated on out-patient modality. GDP-R regimen represents a valid treatment for aggressive
relapsed/refractory B-cell lymphoma not eligible for HDT thanks to its efficacy and good toxic profile. Conclusion: The number
of previous chemotherapeutic regimens and IPI value select those who benefit more from this treatment.

Key words: Cisplatin; dexhametazone; GDP; gemcitabine; relapsed/refractory diffuse large B-cell lymphomas

INTRODUCTION significant activity in heavily pre-treated patients with NHL
even after autologous stem cell transplantation (ASCT). Its
Diffuse large B-cell lymphomas (DLBCLs) are quite often favorable toxicity profile allows its use in combination
curable with intensive combination chemotherapy. Despite regimens with other cytotoxic drugs and anti-CD20-
the improvement of outcome with chemoimmunotherapy, targeted therapy with an overall response rate (ORR) of
30-40% of patients relapse after the first-line treatment, and 50-60% in different phase II studies. [5-9] In the present
the rate of the second complete remission is lower than retrospective study, we described the experience of our
30%. [1-3] Management of these cases is not well-established. institution about the use of gemcitabine in association
High-dose therapy (HDT) with hematological stem-cell with cisplatin, dexamethasone, and rituximab (GDP-R),
support is the standard treatment for chemosensitive in relapsed/refractory DLBCLs not eligible for (HDT)
patients. Induction salvage therapies are usually based with hematological stem cell support. The principal aims
on platinum and etoposide: R-DHAP (rituximab, of this study were to evaluate the overall survival (OS)
dexamethasone, cytosine arabinoside, and cisplatin) and and treatment failure (TTF) and the prognostic factors
R-ESHAP (rituximab, etoposide, methylprednisone, impacting OS and TTF.
Ara-C, and cisplatin) are generally used, but they are
[4]
often characterized by poor responsiveness and significant This is an open access article distributed under the terms of the Creative
Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows
toxicity. Gemcitabine, an antimetabolite drug, has shown others to remix, tweak, and build upon the work non-commercially, as long as
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www.jcmtjournal.com How to cite this article: Ghio F, Cervetti G, Cecconi N, Pelosini M,
Galimberti S, Morganti R, Ferrari P, Nicolini A, Petrini M. Prognostic
factors and efficacy of GDP-R therapy in refractory/relapsed diffuse
large B-cell lymphomas not eligible for high-dose therapy. J Cancer
DOI: Metastasis Treat 2016;2:59-63.
10.4103/2394-4722.172291
Received: 09-07-2015; Accepted: 24-11-2015.

© 2016 Journal of Cancer Metastasis and Treatment ¦ Published by OAE Publishing Inc. 59