Abstract
BackgroundDiffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin’s lymphoma with a five-year survival of 60%-70% with chemoimmunotherapy consisting of the R-CHOP combination (rituximab, cyclophosphamide, vincristine, doxorubicin, and prednisone), with a relapse/refractory rate of 20-50%. Salvage therapy with HDT-ASCT is the treatment of choice for patients with relapsed/refractory disease with a success rate of 50%-60%. Patients who do not respond to the first salvage regimen or who relapsed after the first salvage regimen, with or without high-dose chemotherapy (HDT)-autologous stem cell transplantation (ASCT), have poor overall responses and survival and should be offered novel therapies. The objective of our study was to evaluate responses to second salvage, gemcitabine-based therapy with or without HDT-ASCT in a resource-limited setting.Materials and methodsThis was a retrospective study, including 55 patients aged >18 years, diagnosed with DLBCL and having received gemcitabine-based second salvage chemotherapy.ResultsThe median age was 34 years, only one patient achieved progression-free survival (PFS) of >12 months with ORR of 27% to two cycles of gemcitabine-based combination, two years PFS and OS of 9.6% and 34%, respectively, and a median PFS and OS of four months and 13 months, respectively.ConclusionDLBCL patients, refractory to first-line and first salvage chemotherapy, should be considered for novel therapies or opt for palliative care rather than second salvage chemotherapy and HDT-ASCT, which results in poor overall response and significant toxicities.
Highlights
Non-Hodgkin’s lymphoma is ranked the sixth most common malignancy in Pakistan as per Globocan 2018 data with 5876 patients registered in 2018 amounting to 3.4% of the total cancer patient population [1]
Refractoriness to first salvage or relapse after high-dose chemotherapy (HDT)-autologous stem cell transplantation (ASCT) has remained an area of unmet need until recently where novel therapies including antibody-drug conjugates, bi-specific T-cell engagers (BiTE) antibodies, checkpoint inhibitors, and CAR-T cell therapy have provided hope
Our study shows quite poor progression-free and overall survival with gemcitabine-based second salvage chemotherapy
Summary
Non-Hodgkin’s lymphoma is ranked the sixth most common malignancy in Pakistan as per Globocan 2018 data with 5876 patients registered in 2018 amounting to 3.4% of the total cancer patient population [1]. The addition of rituximab, an anti-CD-20 monoclonal antibody, to the standard CHOP-like combination in elderly patients yielded significant improvement in event-free survival (EFS) and overall survival (OS) with complete responses of 76% and OS of 70% at two years in the rituximab group as compared to 63% and 57%, respectively, in those who did not receive rituximab [6,7] These results were further confirmed by a trial conducted in the younger patient population with a six-year EFS of 74% with rituximab as compared to 56% without rituximab. Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin’s lymphoma with a five-year survival of 60%-70% with chemoimmunotherapy consisting of the R-CHOP combination (rituximab, cyclophosphamide, vincristine, doxorubicin, and prednisone), with a relapse/refractory rate of 20-50%. The objective of our study was to evaluate responses to second salvage, gemcitabine-based therapy with or without HDT-ASCT in a resource-limited setting
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