Gemcitabine and plasmacytic non-Hodgkin lymphoma response.

Abstract

e19537 Background: Lymphomas are highly sensitive to chemotherapy. Gemcitabine is an active agent in non-Hodgkin lymphomas NHL. It is a diflourinated analogue of deoxycytadine which acts as antimetabolite. It is cell cycle specific and blocks cells in the G1/S interface. Gemcitabine is a better substrate for transport into cells. Active phosphorylated form is more readly and is excreted more slowly than other drugs. It inhibit DNA synthesis via depletion of cellular deoxynucleotide pools and by way of masked DNA chain termination. Gemcitabine seem to work it best on indolent and plasmacytoid low grade and intermediate NHL. Gemcitabine is also an active agent in Hodgkin lymphoma, Diffuse large B Cell NHL and T cell lymphomas. Methods: Retrospective reviews of patients with B cell NHL treated with gemcitabine as a single agent or in combination was carried out in one single institution over the last 13 years. Reveiw of biopsy reports and histology with immunostaining and flowcytometry done. This include CD20, CD10, BCL2, BCL6, MUM1, CD5, and cyclin D1. Clinical correlation with outcome CR, PR and Overall survival was done. Results: Forty patients with B cell lymphoproliferative disorders NHL were identified; five with mantle cell, ten with marginal zone and plasmacytoid morphology, fifteen with Diffuse Large B Cell Lymphoma DLBCLand ten with other low grade morphology. No correlation with germinal type versus post germinal (activated type) found in term of response. Plasmacytoid/ marginal zone type and mantle cell seem to have the best significant durable response when compared to DLBCL and other low grade NHL. Of note most patients received gemcitabine after failure to rituximab-CHOP and as salvage therapy in post second- and third-line failure. Conclusions: Gemcitabine may have more durable activity if used as a first-line combination therapy. Larger group of patients analysis needed to see if this agent has more activities in germinal than activated type of DLBCL. Plasmacytoid NHL seem to have more rapid and durable respone in our analysis.