Efficacy of GDP Regimen for Patients with Aggressive Relapsed or Refractory Non-Hodgkin's Lymphoma

Objective: To evaluate the efficacy and safety of chemotherapy regimen with gemcitabine combined with cisplatin and dexamethasone(GDP) for patients with aggressive relapsed or refractory NHL.Methods: From May 2003 to May 2008,53 patients with aggressive relapsed(35 cases)or refractory(18 cases)NHL were enrolled in this study.The T-cell and B-cell origin NHL were 30 cases and 23 cases respectively.There were 44 patients with median-grade aggressive NHL who had been pretreated with chemotherapy dominated by CHOP or CHOP-like regimen at least 2 cycles.9 patients with high-grade aggressive NHL had been pretreated with HyperCVAD regimen more than 2 cycles.Local radiotherapy was given to 22 patients before.All of these patients were administered with GDP regimen,3 weeks to 4 weeks for a cycle,total 2-6 cycles.Results: All these patients received GDP regimen with an average of 4.4 cycles(total 231 cycles).All patients were assessable in the efficacy and adverse events.The RR was 52.8%(28/53) with complete response(CR) rate of 24.5%(13/53).The CR and RR of refractory NHL was 5.6% and 33.3%,and then that of relapsed NHL was 34.3% and 62.9% respectively.There was significant difference for CR and RR between relapsed NHL and refractory NHL(P0.05).Similar results were observed for LDH levels and different grade aggressive NHL(P0.05).The median follow-up time was 36 months(ranged 5～51 months).It was observed for median time to recurrence of 7 months(ranged 3～34 months),median survival time of 11 months(ranged 3～51 months).The 1-year and 2-year survival rate was 35.0% and 11.4%,respectirely.There was no significant difference for overall survival time between relapsed NHL and refractory NHL.The major adverse reaction was toxicity of borrow.The borrow toxicity with Ⅲ～Ⅳ level of neutropenia and thrombocytopenia were 39.6% and 26.4% respectively.Conclusion: GDP regimen is effective and safe for patients with median-grade aggressive relapsed or refractory NHL,but the protocol'efficacy is worthy to be confirmed as a salvage for high-grade aggressive relapsed or refractory NHL.Elevated serum LDH,primary refractory disease and high-grade aggressive disease have a poor response rate.