Retreatment with Gemcitabine Still Hold Efficacy in Relapsed Lymphomas.

Lymphomas are highly sensitive to chemotherapy. Approximately half of the patients with aggressive Non-Hodgkin’s Lymphoma will survive for five years. Patients with diffuse large B-cell type NHL have an expected five years survival( OS) rate of fourty five percent (45%). Approximately more than twenty five percent (25%) of NHL and ten percent 10% of Hodgkin’s Lymphoma HD are refractory to conventional front line therapy. Fifteen to twenty five percent of hodgkin’s lymphoma will relapse after therapy or will not achieve complete response CR. Salvage chemotherapy, radiation and high dose chemotherapy with stem cells collection can cure and achieve durable response in some refractory or relapsed patients. High dose chemotherapy and autologous stem cells transplant is not a feasible options for many of our patients due to lack of medical coverage and co-morbide status. Gemcitabine has been used either as a single agent or in combination at our institute in the treatment of variety of hematological malignancies that failed many lines of therapy. Forty patients were treated; twenty two (55%)NHL, nine patients(19%) with HD, three patients with visceral mycosis fungoides, three patients with advanced chronic lymphocytic leukemia in richter transformation and three with peripheral T cell NHL. Mean age of 45 years. Thirty two males and eight females. Eighty percent were african american. All patients had advanced stage III-IV disease. Complete respose CR and near complete response nCR was seen in eleven patients. Partial response PR seen in nineteen patients, stable disease in six. Total response rate of eighty percent. Five patients relapsed after a year (two 25 years old females with HD, three males with high grade NHL age 52, 60 and 70 respectively). Two patients recieved four cycles and three recieved six cycles. Each cycle constitute of 1 gram per meter square given IV weekly for three weeks and one week rest. All five patients had response, three CR and two PR. In conclusion retreatment with gemcitabine is a valid and safe option. None of the patients had grade 3 or 4 toxicity.