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Gemcitabine as a Single Agent in the Treatment of Relapsed or Refractory Aggressive Non-Hodgkin's Lymphoma

From the Westdeutsches Tumorzentrum, Essen, Germany; Istituto Clinico Humanitas, Rozzano-Milano, Italy; Medizinische Klinik III, Klinikum Großhadern, München, Germany; Universitätskliniken des Saarlandes, Homburg-Saar, Germany; Sädtisches Krankenhaus Leverkusen, Germany; Eli-Lilly, Bad Homburg, Germany, and Florence, Italy; and Istituto Nazionale Tumori, Milano, Italy.

Address reprint requests to A. Fosså, MD, PhD, Department of Immunology, The Norwegian Radium Hospital, Montebello, 0310 Oslo, Norway; email alexanfo{at}labmed.uio.no

PURPOSE: A multicenter phase II trial was conducted to evaluate the efficacy and toxicity of gemcitabine in patients with relapsed or refractory aggressive non-Hodgkin's lymphomas (NHL).

PATIENTS AND METHODS: Thirty-one patients with B-cell intermediate or high-grade NHL (Working Formulation) were enrolled onto the study. The median age was 61 years, with a Karnofsky performance status of 80% in 65% of patients. Forty-eight percent had stage III or IV (Ann Arbor Classification) at study entry. Pretreatment consisted of one, two, or three chemotherapeutic regimens in nine, 11, and 11 patients, respectively. Gemcitabine 1,250 mg/m² was administered intravenously over 30 minutes on days 1, 8, and 15 of a 28-day schedule.

RESULTS: Thirty patients were assessable for efficacy, and 31 were assessable for toxicity. No complete responses were observed, but six patients showed a partial response, 11 stable disease, and 13 progressive disease. The overall response rate was 20% (95% confidence interval, 8% to 39%) for assessable patients and 19% (95% confidence interval, 8% to 34%) for the intent-to-treat analysis. The median duration of partial response was 6 months (range, 3.7 to 15+ months). Nonhematologic World Health Organization grade 3 toxicity included hepatic toxicity in four patients and infection in two. Hematologic toxicity was observed as grade 3 anemia in three patients, grade 3 leukopenia in two patients, grade 3/4 neutropenia in two patients, and grade 3/4 thrombocytopenia in six patients.

CONCLUSION: The present schedule of gemcitabine displays modest efficacy and mild toxicity in pretreated aggressive NHL.

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