title: Rituximab, Gemcitabine, Cisplatin and Methylprednisolone (R-GEM-P) is an effective regimen in relapsed diffuse large B-cell lymphoma.
abstract: BACKGROUND
  Patients with relapsed diffuse large B-cell lymphoma (DLBCL) have a poor prognosis. Gemcitabine, methylprednisolone, cisplatin +/- rituximab (GEM-P+/-R) is a salvage regimen with limited overlap in toxicity with first-line therapy and short duration of inpatient delivery.
  
  
  METHODS
  We assessed the efficacy and safety of GEM-P+/-R in a retrospective single-centre analysis including patients meeting criteria of ≥ 18 yr of age, histologically proven DLBCL, treated between 2001 and 2011 in second-line with gemcitabine 1000 mg/m(2) day 1, 8 and 15, methylprednisolone 1000 mg day 1-5, cisplatin 100 mg/m(2) day 15 (replaced with carboplatin AUC5 if contraindication/toxicity) +/- rituximab 375 mg/m(2) day 1 and 15, every 28 d.
  
  
  RESULTS
  Forty-five patients aged 25-74 received a median of three cycles of GEM-P+/-R; 64% received rituximab. In 44 evaluable patients receiving GEM-P+/-R, overall response rate (ORR) was 48%; in 28 evaluable patients treated with rituximab + GEM-P (R-GEM-P), ORR was 61%. With median follow-up of 50.5 months (95% CI: 28.3-72.7), 3-yr overall survival (OS) from start of GEM-P+/-R was 31.4% (95% CI: 16.5-46.3); in patients treated with R-GEM-P, 3-yr OS was 49.1% (95% CI: 28.7-69.5). Predominant grade ≥ 3 toxicities were haematological; thrombocytopenia 69%, neutropenia 60% and febrile neutropenia 7%.
  
  
  CONCLUSIONS
  R-GEM-P is a deliverable regimen with useful activity in second-line treatment of DLBCL. Our data suggest that rituximab should be given concurrently.
authors.affiliation: The Royal Marsden NHS Foundation Trust, London, Surrey, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Barton
authors.forename: Eliza A
authors.initials: EA
authors.lastname: Hawkes
authors.forename: David
authors.initials: D
authors.lastname: Cunningham
authors.forename: Clare
authors.initials: C
authors.lastname: Peckitt
authors.forename: Sue
authors.initials: S
authors.lastname: Chua
authors.forename: Andrew
authors.initials: A
authors.lastname: Wotherspoon
authors.forename: Ayoma
authors.initials: A
authors.lastname: Attygalle
authors.forename: Alan
authors.initials: A
authors.lastname: Horwich
authors.forename: Mike
authors.initials: M
authors.lastname: Potter
authors.forename: Mark
authors.initials: M
authors.lastname: Ethell
authors.forename: Claire
authors.initials: C
authors.lastname: Dearden
authors.forename: Mary
authors.initials: M
authors.lastname: Gleeson
authors.forename: Ian
authors.initials: I
authors.lastname: Chau
mesh_terms: D000328:Adult; D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols; D016190:Carboplatin / Q000008:administration & dosage / Q000009:adverse effects; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D003841:Deoxycytidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D004334:Drug Administration Schedule; D057915:Drug Substitution; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced / Q000473:pathology; D012008:Recurrence; D012189:Retrospective Studies; D000069283:Rituximab; D016879:Salvage Therapy / Q000379:methods*; D016019:Survival Analysis; D013921:Thrombocytopenia / Q000139:chemically induced / Q000473:pathology; D016896:Treatment Outcome; D000093542:Gemcitabine
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D003841:Deoxycytidine; D000069283:Rituximab; D016190:Carboplatin; D002945:Cisplatin; D008775:Methylprednisolone; D000093542:Gemcitabine
keywords: cisplatin; diffuse; gemcitabine; large B-cell; lymphoma; relapse; rituximab