Unexpected cutaneous toxicity of IGEV regimen in patients with Hodgkin lymphoma.

Abstract

e18543 Background: IGEV (ifosfamide, gemcitabine, vinorelbine, and prednisolone) is an active regimen increasingly used in relapsed/refractory Hodgkin lymphoma (HL) before autologous stem cell transplantation with CR and adequate CD34+ cell collection rate of more than 50% and 90%, respectively. No substantial non-hematological toxicity had been reported so far. Methods: Between December 2009 and October 2010, 12 patients (pts): 5 female and 7 male, median age of 35, range: 23-51, with refractory HL received IGEV regimen. 10 pts were diagnosed with refractory classical HL NS type, one male pts had HL transformed from follicular lymphoma, one female pts had classical HL partly transformed to diffuse large B-cell lymphoma and additionally received rituximab. Results: Of a total of 44 cycles followed by G-CSF support, 4 (9%) were delayed and dose reduced due to grade 3/4 hematologic toxicity. 6 pts, 5 female and 1 male (50%) experienced cutaneous toxicity including grade 3/4 reactions in 4/6 pts (60%). Skin symptoms included rash, maculopapular pruritic eruptions and vesicular erythema with serous effusion in 2 pts. Lesions were itchy or burning, located on the trunk and extremities. Skin symptoms occurred repeatedly after each cycle and resolved within 10-14 days with glucocorticoid and antihistaminic treatment. In 1 case, IGEV chemotherapy was terminated due to prolonged itching and burning sensations. Of 11 evaluable pts, 7 responded (64%) with CR in 4 pts (36%). Conclusions: Reportedly, rate of cutaneous adverse events related to gemcitabine monotherapy is up to 30%. Unexpectedly high incidence of skin events in our pts might have resulted from peculiar toxic synergy of combination agents. The only clinical characteristic apparently related to skin toxicity of gemcitabine was female sex.