Gemcitabine, Dexamethasone And Cisplatin Research Articles

Outcome of Relapsed and Refractory Peripheral T-Cell Lymphoma (PTCL) with Intention for Curative Therapy Incorporating High Dose Chemotherapy and Hematopoietic Stem Cell Transplant (HDC/SCT)

Outcome of Relapsed and Refractory Peripheral T-Cell Lymphoma (PTCL) with Intention for Curative Therapy Incorporating High Dose Chemotherapy and Hematopoietic Stem Cell Transplant (HDC/SCT)

Gemcitabine, dexamethasone and cisplatin (GDP) is an effective and well-tolerated mobilization regimen for relapsed and refractory lymphoma: a single center experience

Background/aim Gemcitabine, dexamethasone and cisplatin (GDP) is a well-established salvage regimen for relapsed and refractory lymphomas. In this study, we aimed to share our experience with the patients who received GDP/R-GDP (rituximab-gemcitabine, dexamethasone and cisplatin) for stem cell mobilization. Materials and methods Data of 69 relapsed and refractory Hodgkin lymphoma (HL) and Non-Hodgkin lymphoma (NHL) patients who received GDP/R-GDP as salvage chemotherapy in our center between July 2014 and January 2020 were retrospectively evaluated. After the evaluation of response, 52 patients had a chemosensitive disease and underwent mobilization with GDP/R-GDP plus G–CSF (granulocyte colony-stimulating factor). Collected CD34+ stem cells and related parameters were compared in terms of diagnosis of HL and NHL, early and late stage, patients who did not receive RT and those who received RT, and patients aged under 60 and over 60. Results On the 15th day on average (range 11–20), a median number of 8.7 × 106 /kg (4.1–41.5) CD34+ stem cells were collected in 51 (98%) of our 52 chemosensitive patients and 1 (2%) patients failed to mobilize. We observed acceptable hematological and nonhematological toxicity. The targeted amount of 2 × 106 /kg CD34+ stem cells was attained by 98% (n: 51) patients, and all of them underwent autologous stem cell transplantation. Moreover, low toxicity profiles provide outpatient utilization option clinics with close follow-up and adequate supportive care. Conclusion We suggest that GDP/R-GDP plus G-CSF can be used as an effective chemotherapy regimen for mobilizing CD34+ stem cells from peripheral blood in relapsed and refractory lymphoma patients due to low toxicity, effective tumor reduction, and successful stem cell mobilization. It can also be assumed that the GDP mobilization regimen may be more effective, especially in patients with early-stage disease and in HL patients.

Obinutuzumab Plus Gemcitabine, Dexamethasone and Cisplatin (O-GDP) As Salvage Chemotherapy Prior to Autologous Stem Cell Transplant in Aggressive B Cell Lymphoma

Background: CCTG LY.12 defined GDP (gemcitabine, dexamethasone and cisplatin) (GDP) as an effective outpatient salvage chemotherapy regimen in relapsed/refractory (R/R) patients with aggressive lymphomas who are candidates for autologous stem cell transplant (ASCT) (Crump et al. JCO 2014). Obinutuzumab (O) is an alternative anti-CD20 that may produce responses in rituximab-refractory lymphomas. Head-to-head, O did not improve efficacy compared to R when combined with CHOP as initial therapy (Vitolo JCO 2017). However, salvage therapy differs from initial therapy in that patients have been previously exposed to, and have relapsed after, prior R. We therefore performed a single centre, single arm clinical trial of O-GDP to assess safety and efficacy in R/R aggressive B cell lymphoma as a salvage regimen prior to consolidation with ASCT. Methods: Transplant eligible patients with DLBCL and transformed indolent lymphoma were treated with O-GDP for two cycles, followed by response assessment by CT. Non-progressers received a third cycle of O-GDP for stem cell mobilization and final response assessed by CT-PET prior to ASCT. O was given at 1000 mg weekly during the first cycle of GDP and then on day 1 of cycles 2 and 3. Responses were determined by Lugano criteria using investigator assessment. The primary outcome is ORR by CT imaging after 2 cycles. The pre-specified statistical analysis stated that the trial will be declared positive if the ORR is >60%, negative if the ORR is <40% and indeterminate if in-between. Secondary outcomes included complete metabolic response rate after 3 cycles of O-GDP and the rate of proceeding to ASCT. Exploratory outcomes included measurements of circulating tumor (ct) DNA during protocol therapy, and analysis of individual mutations. Double-hit score and cell of origin assessments were as previously described (Ennishi et al. JCO 2019). Outcomes: 30 patients were enrolled with a median age of 59.5 years (range 30 - 70). 20 patients had DLBCL, 9 had transformed indolent lymphoma (TRIL; all but one patient having transformed follicular lymphoma) and 1 patient had follicular lymphoma grade 3B. IPI at diagnosis was 0-1 (20% of patients), 2 (30%) or 3+ (50%). Dose delays of O during cycle 1 occurred in 10% of patients due to toxicity with delays in cycle 2 or 3 of O-GDP in 30% of patients. 87% of patients had a dose reduction of chemotherapy with 46% of day 8 gemcitabine doses being held or reduced. Grade 3-4 AEs were seen in 87% of patients (grade 3-4 neutropenia: 77% [febrile neutropenia: 13%]; grade 3 anemia: 13%; grade 3-4 thrombocytopenia: 43%). The ORR (CR + PR) by CT imaging after 2 cycles of study therapy was 60% (95% CI 41-77%). The best ORR (by Lugano criteria including PET/CT) after 3 cycles of study therapy was 70% (51-85%; CMR in 33%) of patients. Of all enrolled patients, 67% (47-83%) proceeded to ASCT. With a median follow up 1.3 years for all enrolled patients, the estimated 1 year OS was 76% (62-93%) and PFS was 59% (44-80%). The OS and PFS in transplanted patients at 1 year was 90% (77-100) and 70% (53-93%) respectively with a median follow-up of 1 year. In post hoc subset analysis, de novo DLBCL had a best ORR of 55% while TRIL/FL3B had an ORR of 100%. The presence of the double hit (DHIT) signature and cell of origin (COO) by gene expression was analyzed in 26/30 patients. Best ORR for DHIT positive was 3/4 patients (75%), DHIT negative was 11/16 (69%) and DHIT indeterminate was 5/6 (83%). Best ORR for ABC-type was 7/10 (70%), GCB-type was 9/13 (69%), unclassified was 1/1 (100%) and PMBL was 1/2 (50%). Conclusions: O-GDP is a feasible outpatient salvage regimen that enables ASCT in patients with R/R aggressive B cell lymphoma across histological and molecular subtypes. Higher rates of cytopenias with O-GDP contributed to treatment delays and dose reductions or holds. Further mutational analysis will be presented. The ORR of 60% met the study primary endpoint and the 1 year OS and PFS are encouraging. Disclosures Jain: Kite/Gilead: Consultancy. Prica:Celgene: Honoraria; Janssen: Honoraria. Kukreti:Amgen: Honoraria; Takeda: Honoraria; Celgene: Honoraria. Kridel:Gilead Sciences: Research Funding. Crump:Servier: Consultancy; F. Hoffmann-La Roche Ltd: Consultancy, Research Funding; Kite/Gilead: Consultancy. Scott:Roche/Genentech: Research Funding; Celgene: Consultancy; Janssen: Consultancy, Research Funding; NanoString: Patents & Royalties: Named inventor on a patent licensed to NanoSting [Institution], Research Funding. Kuruvilla:Abbvie: Consultancy; Seattle Genetics: Consultancy; Merck: Consultancy; Janssen: Honoraria; Karyopharm: Honoraria; Celgene: Honoraria; Gilead: Honoraria; Seattle Genetics: Honoraria; Roche: Honoraria; Roche: Consultancy; Karyopharm: Consultancy; Novartis: Honoraria; Gilead: Consultancy; Janssen: Research Funding; Roche: Research Funding; BMS: Consultancy; Merck: Honoraria; BMS: Honoraria; Astra Zeneca: Honoraria; Amgen: Honoraria. OffLabel Disclosure: Obinutuzumab is an anti-CD20 antibody being tested here in a prospective clinical trial for relapsed/refractory aggressive B cell lymphomas

Upfront radiation is essential for high-risk early-stage extranodal NK/T-cell lymphoma, nasal type: comparison of two sequential treatment modalities combining radiotherapy and GDP (gemcitabine, dexamethasone, and cisplatin) in the modern era

Early/upfront radiation was associated with improved survivals compared with late radiation for early-stage NK/T-cell lymphoma (NKTCL) in the old era when anthracycline-base chemotherapy (CT) prevailed. However, in the modern era of effective l-asparaginase/gemcitabine-based CT, the optimal timing of radiation is unclear. In this study, 75 patients with newly diagnosed NKTCL, who were treated with combined involved-field intensity-modulated radiotherapy and GDP (gemcitabine, dexamethasone, and cisplatin) were retrospectively reviewed, including 45 from the RT + CT group and 30 from the CT + RT ± CT group. Compared with CT + RT ± CT, RT + CT sequence achieved superior progression-free survival (5-year PFS: 81.6% vs. 56.0%, p = .017) and locoregional control (LRC) (90.8% vs. 66.9%; p = .020). Responses, overall survivals or adverse event incidences did not differ across the groups. Upfront RT was a powerful prognostic variable for favorable PFS (HR 0.302; 95% CI: 0.125–0.729; p = .008). It indicated that upfront RT administration remains vital in enhancing LRC and survival for localized NKTCL in the modern era.

PS1534 EFFICACY AND SAFETY OF STEM CELL MOBILISATION FOLLOWING GDP SALVAGE IN PATIENTS WITH RELAPSED OR REFRACTORY LYMPHOMA

Background:High‐dose chemotherapy and autologous stem cell transplant (ASCT) remains a key treatment strategy in patients with relapsed/refractory (R/R) aggressive lymphoma. CCTG study LY.12 established gemcitabine, dexamethasone and cisplatin (GDP) as a standard salvage chemotherapy regimen for R/R lymphoma across Canada. Peripheral blood stem cell (PBSC) mobilisation on this salvage regimen can be achieved using granulocyte colony‐stimulating factor (GCSF) during salvage (GDP) or following an additional course of cyclophosphamide and etoposide (CE) at completion of salvage GDP; however these strategies have yet to be compared.Aims:To compare the efficacy and safety of PBSC mobilisation with GDP to our previous standard of CE since GDP was adopted as standard salvage therapy for R/R lymphoma.Methods:All patients undergoing PBSC mobilisation following salvage GDP for R/R lymphoma from January 2012 to August 2018 were included in this analysis. CE comprised C 2 g/m2 d1, E 200 mg/m2 d 1–3, and GCSF 10 μg/kg d4–12, with apheresis planned d13. For collection following GDP, GCSF was added 10 μg/kg d9–14, apheresis starting d15. Apheresis started when the blood CD34 count was ≥10 cells/μl, with target collection of ≥5 x 106 CD34+ cells/kg. From May 2014 plerixafor 24 μg/kg was added to GCSF in the event of slow or inadequate mobilisation. Primary outcomes were PB CD34+ count on planned day of apheresis and total CD34+ yield. Secondary outcomes included number of apheresis days, febrile neutropenia after mobilisation, time to engraftment, days admitted for transplant, blood product usage, PFS and OS.Results:A total of 339 patients underwent PBSC mobilisation, 210 following GDP and 129 after CE. Patients in the GDP group had more delays from planned to actual day of collection (mean 0.7 vs 0.4 days, p = 0.006) and required more total days of apheresis (median 2 vs 1 day; p = 0.001). The percentage of GDP patients collected on planned day of harvest and who required only one day of apheresis were 71% and 50% respectively, versus 84% and 69% respectively after CE. ROC curves (Figure 1) for platelets, neutrophils and PB CD34+ measured on planned day of collection confirm PB CD34+ as the best predictor for successful attainment of target CD34+ yield. In multivariable analysis, CE led to both higher PB CD34+ count on planned day of harvest and higher total CD34+ yield (both p < 0.001), despite a higher rate of plerixafor use in the GDP group (37/210 vs 6/129). However, when considering a target total CD34+ yield ≥5x106/kg there was no difference between mobilisation regimens (p = 0.66). Similarly, on multivariable analysis, days to engraftment, ASCT admission duration and platelet transfusions required showed no statistical difference between the two mobilisation strategies; patients mobilised with CE required more RBC transfusion during ASCT (p = 0.04). Of interest, prior bone marrow involvement and use of plerixafor were both predictors for longer engraftment time (p = 0.013 and p = 0.007 respectively), after adjustment for mobilisation and CD34+ yield. Although total CD34+ yield was not associated with days to engraftment on multivariable analysis, it was independently associated with blood product usage and day 100 blood count recovery. In multivariable Cox analyses, disease status at time of ASCT was the main predictor of PFS and OS.Summary/Conclusion:While CE/GCSF appears to be a more efficient method of mobilisation in patients undergoing GDP salvage for R/R lymphoma, this did not translate to significant differences in clinical outcomes such as engraftment or duration of hospital admission.image

Prognostic Significance of Neutrophil to Lymphocyte Ratio (NLR) in Relapsed/Refractory Aggressive Lymphoma Salvage Chemotherapy — Analysis ofCanadian Cancer Trials Group (CCTG)ly.10 Trial

Background: The neutrophil to lymphocyte ratio (NLR) at the time of diagnosis has been shown as a prognostic marker to predict outcomes of treatment in patients with aggressive lymphoma in both non-Hodgkin (NHL) and Hodgkin lymphoma (HD). The growing evidence that tumor microenvironment, host immunity and inflammatory responses play an important role in progression of different malignancies supports this rationale. The prognostic significance of NLR has only been studied in the frontline setting in HD and NHL. Therefore the aim of this study is to evaluate correlation of NLR with response to salvage therapy in patients with relapsed or refractory aggressive lymphoma.Methods: This is a retrospective review of participants in the CCTG LY.10 trial, a phase 2 clinical trial evaluating treatment with Gemcitabine, Dexamethasone and Cisplatin (GDP) in patients with relapsed or refractory NHL and HD who are eligible for Autologous Stem Cell Transplantation (ASCT). Seventy-seven patients were treated with GDP, 23 with HD and 51 with NHL. The overall response rate (ORR) including complete and partial response to GDP salvage therapy was 69.5% in HD and 49% in NHL. NLR was calculated on all patients at the time of relapse. Biomarker Threshold Models (Chen et al, 2014, Computational Statistics and Data Analysis, V71, page 324-334) were applied to identify the optimal cut off point for NLR. Categorical variables were compared using Chi-square test and survival distributions were compared using KM curves and Log-rank test.Results:A NLR of 8.4 was determined to be the optimal cut-off for prognosis. Among the full cohort of 77 patients, ORR in those with a NLR of < 8.4 was 70.6%, as compared with 33.4% for those with a NLR of > 8.4 (p=0.005). In the HD cohort the RR was 86.7% vs 50% (P =0.059) and was 63.9% vs 26.7% in the NHL cohort (P =0.015). In NHL the ability to proceed to transplant was correlated with NLR of <8.4 with 52.7% vs 20% of patients proceeding to ASCT (P = 0.031). All patients with HD proceeded to transplant regardless of their NLR. Patients with NLR <8.4 had better progression free survival (PFS) at 12 months; 100% vs 71% in patients with HD (P = 0.028) and 27 % vs 11% in patients with NHL (P =0.05).Conclusion:NLR is a readily available marker correlated with outcomes (ORR, transplant rate and PFS) and can be used to identify high risk patients at the time of relapse of aggressive lymphoma. This easily measurable prognostic marker would be especially useful in the era of novel treatment options to identify higher risk patients. Further analysis on larger data sets are required to validate this finding. DisclosuresHay:Seattle Genetics: Research Funding; Roche: Research Funding; Janssen: Research Funding; Novartis: Research Funding; Amgen: Research Funding; Kite: Research Funding. Baetz:Merck: Membership on an entity's Board of Directors or advisory committees; Roche: Membership on an entity's Board of Directors or advisory committees; Novartis: Membership on an entity's Board of Directors or advisory committees; Seattle Genetics: Research Funding.

Obinutuzumab Plus Gemcitabine, Dexamethasone and Cisplatin (O-GDP) As Salvage Chemotherapy Prior to Autologous Stem Cell Transplant in Aggressive B Cell Lymphoma

Background: The LY.12 randomized phase 3 clinical trial defined gemcitabine, dexamethasone and cisplatin (GDP) as an effective outpatient salvage chemotherapy regimen in relapsed/refractory (R/R) patients with aggressive lymphomas who are candidates for autologous stem cell transplant (ASCT) (Crump et al. JCO 2014). When the anti-CD20 antibody rituximab (R) was added to GDP, the ORR was 45.6% by CT imaging and 51.9% of patients were able to receive ASCT. Obinutuzumab (O) is a type 2 CD20 antibody that has demonstrated superiority to R in some studies in indolent lymphomas and is active in R-refractory follicular lymphoma. Improvements in the outcome of salvage therapy have tested alternative CD20 antibodies (Van Imhoff, JCO 2017), to date without success. We report a single centre, single arm clinical trial of O-GDP to assess safety and efficacy in R/R aggressive B cell lymphoma.Methods: Transplant eligible patients with DLBCL and transformed indolent lymphoma were treated with O-GDP for two cycles, followed by response assessment by CT. Non-progressors received a third cycle of O-GDP for stem cell mobilization and a PET/CT scan was obtained after stem cell collection. Responders then proceeded to ASCT per investigator decision. O was given at 1000 mg weekly during the first cycle of GDP and then on day 1 of cycles 2 and 3. Responses were determined by Lugano criteria using investigator assessment. The primary outcome was ORR by CT imaging after 2 cycles. The pre-specified statistical analysis stated that the trial will be declared positive if the ORR was >60%, negative if the ORR was <40% and indeterminate if in-between. Secondary outcomes included PET CR rate after 3 cycles of O-GDP and the rate of proceeding to ASCT. Exploratory outcomes included measurements of circulating tumor (ct) DNA during protocol therapy, and analysis of individual mutations.Results: The trial has completed its planned accrual of 30 patients. Median age was 59.5 (range 30 - 70), with 40% female, 70% with DLBCL NOS and 30% with transformed indolent lymphoma (all but one patient having transformed follicular lymphoma). IPI at study entry was 0-1 (20% of patients), 2 (30%) or 3+ (50%). Grade 3 or 4 toxicity was observed in 87% of patients. This was mainly myelosuppression with grade 4 neutropenia (47%) and thrombocytopenia (37%). Other grade 4 adverse events were sepsis (2 patients), febrile neutropenia (1 patient) and hypokalemia (1 patient). No grade 5 events were attributed to study treatment. One additional case of myelodysplastic syndrome caused treatment discontinuation. Events necessitating dose reductions (33% of patients), dose delays (23%) and dose holds (23%) occurred in a total of 57% of patients.At the time of submission, data are evaluable for the primary endpoint in 28 patients. The ORR (CR + PR) by CT imaging after 2 cycles of study therapy was 60.7% (95% CI 40.6-78.5) Overall, 65.5% of patients (95%CI = 45.7%-82.1%) proceeded to ASCT. In addition, 15 patients are evaluable by PET/CT after 3 cycles of O-GDP, with 47% attaining a complete metabolic response (Deauville 1 - 3), 40% a partial metabolic response and 13% with no metabolic response by Lugano criteria. Plasma ctDNA measurements were taken at baseline, after 1 cycle of O-GDP, and at the time of PET/CT. CtDNA quantities will be compared to imaging assessments.Conclusions: O-GDP is an outpatient salvage regimen that enables ASCT in patients with R/R DLBCL. Compared to R-GDP there is a greater frequency of grade 3 - 4 toxicity (O-GDP 87%, R-GDP previously reported at 47%), although the difference is mainly due to cytopenias and can be managed by dose adjustments to the GDP regimen. Further data analysis is required to determine if the trial will meet the primary endpoint of an ORR > 60%. The overall rate of proceeding to ASCT with O-GDP salvage in this trial was 65.5% compared to that previously reported for R-GDP at 51.9%. DisclosuresScott:NanoString: Patents & Royalties: Named Inventor on a patent licensed to NanoString Technologies, Research Funding; Roche: Research Funding; Janssen: Research Funding; Celgene: Consultancy, Honoraria. Kuruvilla:BMS: Consultancy, Honoraria; Abbvie: Consultancy; Leukemia and Lymphoma Society Canada: Research Funding; Seattle Genetics: Consultancy, Honoraria; Amgen: Honoraria; Celgene: Honoraria; Karyopharm: Honoraria; Janssen: Consultancy, Honoraria, Research Funding; Princess Margaret Cancer Foundation: Research Funding; Gilead: Consultancy, Honoraria; Lundbeck: Honoraria; Roche: Consultancy, Honoraria, Research Funding; Merck: Consultancy, Honoraria.

Definitive salvage chemotherapy for the treatment of refractory/relapsed non-Hodgkin lymphoma, a single center experience

ObjectiveNon Hodgkin Lymphomas (NHL)s are a group of malignancies which affect the lymphatic system. A significant proportion of NHL patients experience either relapse or failure of treatment which is called refractory disease. Relapsed or refractory NHL usually have poor prognosis due to shortage of randomized trials comparing efficacy of different treatment protocols to define the optimal salvage chemotherapy regimen in these cases. In this study, we are trying to define the best salvage chemotherapy regimen with low toxicity and better quality of life for patients by comparing outcome of 2 salvage chemotherapy regimens GDP & DHAP. Patients and methods100 patients diagnosed as relapsed or refractory NHL were randomly assigned to receive either Gemcitabine, Dexamethasone and Cisplatin (GDP) or Dexamethasone, Cytarabine and Cysplatin (DHAP) for 4 to 6 cycles. Primary endpoints of the study were overall survival and progression free survival. Secondary endpoints were response to treatment, toxicity profile of each regimen, and quality of life assessment. ResultsThe overall response rate was 70% in GDP group & 64% in DHAP group with no statistically significant difference between them (p-value 0.5). There was no significant difference between both groups regarding toxicity profile except in febrile neutropenia episodes which was much less in GDP group (p-value 0.04). Quality of life was better in GDP group than DHAP with significant difference (p-value < 0.05). There was no statistical significant difference between both groups regarding OS or PFS. ConclusionGDP is as effective as DHAP for relapsed or refractory lymphoma with less toxicity and better quality of life.

Intensity-modulated radiation therapy followed by GDP chemotherapy for newly diagnosed stage I/II extranodal natural killer/T cell lymphoma, nasal type.

Extranodal natural killer (NK)/T cell lymphoma, nasal type (ENKTL) is an aggressive non-Hodgkin lymphoma and the majority of ENKTL cases are diagnosed at the localized stage. Radiotherapy in combination with chemotherapy has been used for localized ENKTL, but the optimal combination treatment modality and the best first-line chemotherapy regimen have not been defined. In this retrospective study, 44 patients with newly diagnosed, stages I/II ENKTL were enrolled and received intensity-modulated radiation therapy (IMRT, 50-56Gy) followed by GDP (gemcitabine, dexamethasone, and cisplatin) chemotherapy. The median number of chemotherapy cycles per patient was 4 (range, 2-6 cycles). At the end of treatment, the overall response rate was 95% (42/44), including 39 patients (89%) who attained complete response. Two patients developed systemic progression after IMRT. With a median follow-up of 37.5months, the 3-year overall survival (OS) rate and progression-free survival (PFS) rate were 85% (95% CI, 74 to 96%) and 77% (95% CI, 64 to 91%), respectively. Locoregional and systemic failure rates for this treatment were 9% (4/44) and 14% (6/44), respectively. The most common grades 3 to 4 adverse events included leukopenia (37%), neutropenia (34%), and mucositis (25%). No treatment-related deaths were observed. This study suggested high efficacy and low toxicity of IMRT followed by GDP regimen chemotherapy for newly diagnosed stage I/II ENKTL patients. These results require further investigation in prospective trials.

Phase II clinical trial of first-line combination of radiation followed by gemcitabine, dexamethasone, and cisplatin (GDP) chemotherapy for early-stage extranodal natural killer/T-cell lymphoma with unfavorable prognostic factors: The GREEN study (NCT02276248).

7540 Background: Currently concomitant or sequential chemotherapy with radiotherapy has been recognized as the standard treatment for extranodal natural killer/T-cell lymphoma, nasal type (ENKTL). However, the optimal schedule has not been fully defined. Methods: We designed a phase II prospective study to investigate the efficacy and toxicity profile of sequential radiation followed by systemic GDP (gemcitabine, dexamethasone and cisplatin) chemotherapy on previously untreated early-staged (stage IE/IIE) ENKTL patients with at least one unfavorable prognostic factor. The primary endpoint was 2-year progression-free survival (PFS). Secondary endpoints were 2-year overall survival (OS), overall response rate (ORR), and toxicity. Results: A total of40 patients were enrolled and completed the entire course of treatment between June 2010 and June 2014. The median age was 38 (range 25-63) years old. All the enrolled patients presented with at least one unfavorable prognostic feature: age &gt; 60 years (5.0%), B symptom (40%), elevated serum LDH (40.0%), regional lymph node involvement (32.5%) and primary tumor invasion (87.5%). At the completion of the whole treatment, ORR was 97.5% and the complete remission rate was 95.0%. Median follow-up time was 43.7 months (range 9.4-72.3 months). 2-, 3-, 5-year PFS rates were 84.7%, 82.1%, 77.5%, and OS rates were 89.9%, 87.1%, 79.7%, respectively. Recurrence within the RT field was observed in four patients and systemic failure in three individuals. Grade 1-2 skin reaction and mucositis were the main toxicity related to radiation. Grade 3-4 neutropenia (12/40), thrombocytopenia (7/40) and anemia (2/40) were observed during GDP chemotherapy. No clinically significant late toxicities were observed during follow-up visits. Conclusions: The current results indicates that first-line radiation followed by GDP chemotherapy can be one of the most effective and feasible treatment schedule for early-stage ENKTL patients, especially those with poor prognostic factors. Clinical trial information: NCT02276248.

Preliminary Results of FDG-PET Scanning after GDP Chemotherapy Prior to Autologous Stem Cell Transplant (ASCT) for Relapsed/Refractory (RR) Lymphoma

Introduction:Gemcitabine, dexamethasone and cisplatin (GDP) has become a standard salvage chemotherapy (SC) regimen for relapsed/refractory (RR) lymphoma prior to autologous stem cell transplantation (ASCT) (Crump JCO 2014). Response to SC is now evaluated using 18-Fluoro-deoxyglucose positron-emission-tomography (FDG-PET) scans based on the recent Lugano classification (Cheson JCO 2014). We evaluated the response of patients (pts) with Hodgkin lymphoma (HL) and aggressive non-Hodgkin lymphoma (NHL) to GDP by PET-CT scans and attempted to determine whether PET was predictive of outcome.Methods:We performed a retrospective chart review of consecutive HL and DLBCL (diffuse large B-cell lymphoma) pts who underwent ASCT following GDP SC at our centre between January 2014 and July 2016. All pts previously received anthracycline-based chemotherapy (typically ABVD for HL or R-CHOP for NHL) for primary treatment. Pts underwent FDG-PET scans after 3 cycles of SC and scans were retrospectively reported with the Deauville Criteria Scale with Deauville scores of 1-3 considered negative, whereas scores of 4 or 5 represented a positive result. Response to GDP was documented with CT scans using 1999 Working group Criteria (JCO 1999). Pts proceeded to ASCT if they had a PR by CT imaging and no signs of PD on PET-CT. Post-PET radiation or additional chemotherapy could be given at the discretion of the treating physician. Progression free survival (PFS) and overall survival (OS) were calculated by the Kaplan-Meier method from the date of progression or date of ASCT. Statistical analysis to determine the significance of PET result on outcome was performed using the long rank test.Results: 45 pts with DLBCL and 29 pts with HL were identified: median age was 45 (range: 23-69) and 29 (range: 19-58) years respectively. Baseline patient characteristics are listed in Table 1. Following GDP SC, PET Deauville scores of 1-3 were reported in 55% of HL and 29% of DLBCL pts. Overall response rate to GDP by CT was 72% for HL pts and 64% for DLBCL pts (Table 2). For HL, 100% (16/16) of pts with a PET(-) scan and 91% (10/11) with a PET(+) result proceeded to ASCT. 85% (11/13) of DLBCL pts who had a PET(-) scan and 48% (15/31) with a PET(+) scan underwent ASCT. Additional therapy post PET scan included involved field radiation, additional chemotherapy (mini-BEAM) or novel therapy (brentuximab and bendamustine for HL patients). Median follow-up time was 14.2 months (HL) and 13.4 months (DLBCL) from relapse/progression after initial chemotherapy; and 9.6 months (HL) and 10.9 months (DLBCL) from ASCT. There was a statistically significant difference between PET(+) and PET(-) DLBCL patients from the time of initial disease progression for PFS (26% versus 69%, p=0.011) that did not reach statistical significance for OS (p=0.072). However, there was no significant difference for PFS and OS in DLCBL from ASCT when stratified by PET result (p= 0.154 and p=0.723 respectively). In HL pts, no statistically significant differences for PFS and OS from progression (p=0.480 and p=0.387 respectively) or from ASCT (p=0.579 and p=0.450 respectively) were found when stratified by PET result (see Tables 3 and 4).Conclusion: Deauville 4-5 PET scores appear to be predictive of PFS for RR-DLBCL pts. The lack of a significant difference between PET results for OS in DLBCL is likely due to sample size and the need for longer follow-up. For RR-HL pts, PFS and OS rates were both high but did not seem to noticeably differ by PET result. Additional therapy employed for Deauville 4-5 patients peri-ASCT could influence outcome. Overall, PET response assessment post GDP appears to stratify outcome in patients with DLBCL and PET adapted therapy in HL patients may improve outcome in Deauville 4-5 patients. Review of pending cases and subsequent follow-up is ongoing. [Display omitted] [Display omitted] [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Gemcitabine, dexamethasone, and cisplatin (GDP) as salvage chemotherapy for patients with relapsed or refractory peripheral T cell lymphoma-not otherwise specified.

Standard therapeutic options for patients with relapsed or refractory peripheral T cell lymphoma-not otherwise specified (PTCL-NOS) remain unclear. There are few large cohort studies specifically focused on gemcitabine-based chemotherapy for PTCL-NOS. We retrospectively reviewed patients with relapsed or refractory PTCL-NOS who received salvage GDP (gemcitabine, dexamethasone, and cisplatin) chemotherapy at the Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China, from May 2008 to August 2014. Twenty-five patients were enrolled and analyzed. The median number of cycles of GDP chemotherapy per patient was four (range, 2-8cycles). Overall response rate was 64.0% (16/25) with five achieved complete remission or complete remission unconfirmed. After a median follow-up of 9months, median overall survival (OS) and progression-free survival after relapse or progression (second-PFS) were 9.3 and 5.4months. One-year PFS rate and 1-year OS rate were 27.4% and 43.9%, respectively. Median second-PFS was significantly longer in patients sensitive to GDP than the ones resistant to the treatment (10.3 vs. 2.8months, p<.01). In addition, the low International Prognostic Index, low Prognostic Index for T cell lymphoma, or normal level of LDH in serum was associated with favorable prognosis. Grade 3/4 adverse effect was observed in 10 of 25 patients treated with GDP including neutropenia (8/25), thrombocytopenia (5/25), and anemia (4/25). Taken together, our study suggests that GDP is an effective and optional salvage regimen for relapsed or refractory PTCL-NOS.

GDP (Gemcitabine, Dexamethasone, and Cisplatin) Is Highly Effective and Well-Tolerated for Newly Diagnosed Stage IV and Relapsed/Refractory Extranodal Natural Killer/T-Cell Lymphoma, Nasal Type.

This study was conducted to evaluate the effectiveness and tolerance of GDP (gemcitabine, dexamethasone, and cisplatin) regimen in patients with newly diagnosed stage IV and relapsed/refractory extranodal natural killer/T-cell lymphoma, nasal type (ENKTL).The study enrolled 41 ENKTL patients who received GDP regimen at the Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College between January 2008 and January 2015.The disease status was newly diagnosed stage IV in 15 patients and relapsed/refractory in 26 patients. The median number of cycles of chemotherapy per patient was 6 (range, 2–8 cycles). The overall response rate and complete-remission rate were 83.0% (34/41) and 41.5% (17/41), respectively. After a median follow-up of 16.2 months, 1-year progression-free survival rate and 1-year overall survival rate for the whole cohort were 54.5% and 72.7%. Grade 3 to 4 adverse events included neutropenia (34.1%), thrombocytopenia (19.5%), and anemia (14.6%).Our study has suggested high efficacy and low toxicity profile of GDP regimen in patients with newly diagnosed stage IV and relapsed/refractory ENKTL.

Efficacy of GDP regimen on relapsed and refractory intermediate and high grade non-Hodgkin lymphoma

Objective Treatment of relapsed and refractory non-Hodgkin lymphoma(NHL)remains difficult.This study investigated the efficacy of the GDP(gemcitabine,dexamethasone,and cisplatin)regimen on relapsed and refractory NHL and observed the corresponding adverse events.Methods Clinical data of 32 patients with relapsed and refractory NHL(20 relapsed NHL and 12 refractory NHL)treated with GDP regimen were analyzed.Results All the 32 patients were assessable.The response rate(RR)for the whole group was 59.4 % with complete remission(CR)rate of 21.8 %.Among the 23 patients with B-cell NHL and the 9 patients with T-cell NHL,the response rates were 60.8 % and 55.5 %,respectively.The 1-year overall survival rate was 43.8 %.Major toxicity was myelosuppression with 31.1% and 18.6 % incidence of grade Ⅲ-Ⅳ thrombecytopenia and neutropenia respectively.Nausea and vomiting toxicities were mild.These adverse effects could be treated and there was no treatment-treated death.Conclusion GDP regimen is effective and well tolerated in patients with relapsed and refractory NHL.Further clinical study is needed. Key words: Lymphoma,non-Hodgkin; Drug therapy,combination; Treatment outcome

Addition of Rituximab to Salvage Chemotherapy in Aggressive CD20+ Lymphoma Prior to Autologous Stem Cell Transplant (ASCT): A Cohort Comparison from the NCIC CTG Study LY.12

Abstract Background: The addition of rituximab (R) to salvage chemotherapy has been shown to improve response rates and proportion of patients subsequently transplanted with Aggressive CD 20+ Non-Hodgkin Lymphoma who were previously R naïve. It is unknown if this benefit would be seen in the era of patients requiring ASCT who had previously been treated with R + chemotherapy. Methods: The NCIC CTG study LY.12 is a phase III study that evaluated gemcitabine, dexamethasone and cisplatin (GDP) as a salvage regimen compared with dexamethasone, cytarabine, cisplatin (DHAP), and demonstrated that GDP was non-inferior with respect to response rate and showed similar results for rates of transplantation and event-free survival (Crump et al, ASH 2012; in press JCO 2014). In addition GDP resulted in less toxicity and was highly cost effective compared to DHAP. Between Aug 2003 and Oct 2011, 619 patients (pts) were accrued; 414 had CD 20+ lymphoma and received R with their initial treatment. Ninety six pts were accrued between 2003-05 and received GDP or DHAP without R; following a protocol amendment in 2005, 318 pts received R on day 1 of each cycle of salvage chemotherapy. We compared these two cohorts to determine whether there is a benefit to adding R to DHAP or GDP in those pts who have relapsed or are refractory (stable disease or progressive disease) after R containing first-line treatment. Response assessment by CT scan was performed following two cycles of salvage treatment. Subsequent mobilization, choice of high-dose chemotherapy regimen and use of post-transplant radiation were at investigator discretion. Results: Of the 414 pts in this analysis, median age was 55.7 years (range 18-71); 78% had diffuse large B cell lymphoma and 14.5% transformed from indolent lymphoma; 35% were refractory to first line treatment and 46.9% had relapsed within 1 year; 34.5% had IPI score 3 or higher at study enrolment. 41.3% of pt had an elevated LDH and 33.1% had B symptoms prior to salvage therapy. Most had no prior radiation treatment (78.7%). Equal number of pts in the R+ and R- groups received DHAP as GDP as salvage chemotherapy. The R- group was slightly younger (53.7 vs 56 years, P=0.03), had a higher ECOG Performance status &gt;1 (19.8% vs 11.6%, P=0.041) and a higher proportion of pts relapsing within 1 year of R-CHOP (59.4% vs 43.1%, P=0.002). The rate of CR/Cru (15.7% vs 4.2%, p = 0.0032) and overall RR (45.6% vs 25%, P=0.0003) were significantly better in the R+ group. The transplantation rate was significantly greater in the R+ group 165/318 versus the R- group 30/96 (51.9% vs. 31.3%; P=0.0004). Multivariate analysis revealed that response rate was significantly higher in those receiving R with salvage, longer remission after primary therapy and without B symptoms at relapse. We were unable to detect differences in EFS and OS between the groups who received or did not receive R (4 year EFS 22 vs. 20%, HR = 0.85, P=0.26; 4 year OS 35 vs 31%, HR = 0.83, P=0.18). Conclusion: Although this is a retrospective analysis, these data suggest that in patients with relapsed/refractory CD20+ aggressive lymphoma, the addition of rituximab to subsequent salvage treatment improves RR and the proportion of patients proceeding to ASCT. Additional strategies are required to improve outcomes post-ASCT. Disclosures Baetz: Roche: Consultancy; Lundbeck: Consultancy; Bristol-Myers Squibb: Consultancy. Meyer:Celgene: Honoraria.

The Use Of GDP (Gemcitabine, Dexamethasone and Cisplatin) in The Primary Therapy Of Peripheral T-Cell Lymphomas

IntroductionThe outcome of peripheral T-cell lymphomas (PTCLs) is poor using standard CHOP chemotherapy. Previous studies have shown good single agent activity of gemcitabine in the relapsed/refractory setting. GDP (gemcitabine, dexamethasone and cisplatin) was developed as a secondary chemotherapy regimen in relapsed aggressive lymphomas and in a comparison to DHAP has recently been shown to have equivalent efficacy, a favourable side effect profile, and it can be delivered in the outpatient setting. At the BC Cancer Agency, GDP has recently been integrated into the primary therapy of patients with PTCLs in an attempt to improve outcomes with CHOP chemotherapy in this poor risk population. MethodsThe BC Cancer Agency Centre for Lymphoid Cancer and pharmacy databases were searched to identify all cases of newly diagnosed PTCLs with diagnoses by the WHO classification, (with the exception of ALK-positive ALCL, extranodal NK/T-cell lymphoma, cutaneous T-cell lymphoma and hepatosplenic t-cell lymphoma) that received at least one cycle of GDP chemotherapy integrated into their primary therapy, typically alternating with CHOP. ResultsIn total, 34 patients received GDP as part of their first-line treatment (PTCL-NOS n=19, ALK-neg ALCL n=10, enteropathy-type TCL n=2, angioimmunoblastic T-cell lymphoma n=3) in addition to CHOP chemotherapy. The median age was 58 years, 65% were male and the majority of patients had high risk features including stage 3 or 4 disease (94%), elevated LDH (62%). high IPI score (>3 65%; >2 82%) and 32% had bone marrow involvement. The median number of cycles of GDP was 3 (1-8). Two patients underwent consolidative treatment with high dose chemotherapy and autologous stem cell transplantation in first remission and two patients received consolidative radiotherapy. The overall response rate at the end of primary chemotherapy was 82% (CR 62%). With a median follow-up in living patients of 2.8 years the 1- and 2-year time to progression (TTP) were 50% and 36%, respectively and the corresponding estimates for OS were 78% and 64%. Interestingly, the IPI was not prognostic (2 y TTP IPI 0,1 42%, 2,3 34%%, 4,5 37.5% p=.87) even if the 2 patients undergoing transplant are excluded. GDP was generally well tolerated and only 2 patients discontinued treatment due to toxicity (renal dysfunction/hearing loss and rash) and there were no treatment-related deaths. Two patients were hospitalized for febrile neutropenia following GDP and 9 patients (26%) required GCSF support through their therapy. ConclusionThe use of GDP in the primary treatment of PTCL is associated with a high response rate. Outcomes in high IPI patients compare favourably with historical results using CHOP chemotherapy and suggest that it may be able to overcome disease resistance in this poor risk group, providing rationale to explore it in further in future clinical trials of PTCLs. Disclosures:Connors:F Hoffmann-La Roche: Research Funding; Roche Canada: Research Funding. Savage:Eli-Lilly: Consultancy.

Gemcitabine-based combination regimen in patients with peripheral T-cell lymphoma

This study was conducted to evaluate the efficacy and safety of gemcitabine-based combination regimen in patients with peripheral T-cell lymphoma (PTCL). Between May 2007 and August 2011, 26 consecutive patients with PTCL were enrolled in this study. Of these 26 patients, histology was extranodal NK/T-cell lymphoma, nasal type in 14 (53.9 %), peripheral T-cell lymphoma, not otherwise specified in nine (34.6 %), anaplastic large cell lymphoma, ALK negative in three (11.5 %). The majority of patients had newly diagnosed (65.4 %) and advanced (80.8 %) diseases. Treatment regimen was DIMG (dexamethasone, ifosfamide, methotrexate, and gemcitabine) given to the first 6 patients, and GDP (gemcitabine, dexamethasone, and cisplatin) given to the remaining 20 patients. The median follow-up time was 25 (range 7-60) months. The overall response rate was 88.5 %. Twelve (46.2 %) patients achieved complete remission, 11 (42.3 %) patients achieved partial remission, and 1 (3.8 %) patient had stable disease (SD), two (7.7 %) patients had progressive diseases. The 1- and 2-year progression-free survival rates were 58.7 and 45.9 %, while 1- and 2-year overall survival rates for all patients were 80.6 and 63.7 %, respectively. Adverse events included grade 3 or 4 neutropenia (35.0 %) and thrombocytopenia (15.0 %) from patients treated with GDP. Grade 3 or 4 neutropenia and thrombocytopenia were 100.0 and 66.7 %, respectively, for patients who received DIMG regimen. Our study has demonstrated that the gemcitabine-based combination regimen, especially GDP regimen, is safe and well tolerated with promising clinical activity in patients with PTCLs.

Gemcitabine, Dexamethasone, and Cisplatin (GDP) Is An Effective and Well-Tolerated out-Patient Salvage Therapy for Relapsed/Refractory Diffuse Large B-Cell Lymphoma (DLBCL) and Hodgkin Lymphoma (HL)

AbstractAbstract 113 Introduction:DLBCL and HL represent highly curable lymphoid malignancies. Patients (pts) whose lymphoma is refractory to or relapses following initial therapy pose a significant therapeutic challenge. The goal of therapy is to proceed to a non-cross-resistant salvage regimen followed by high dose chemotherapy (HDC) and stem cell transplantation (SCT) for transplant eligible pts. The optimal choice of salvage therapy remains unknown. The combination of gemcitabine, dexamethasone and cisplatin (GDP) has been shown in phase II studies to induce high response rates with minimal toxicity (Baetz T, Ann Oncol, 2003; Crump M, Cancer, 2004). Based on these promising results, British Columbia Cancer Agency (BCCA) policy has recommended GDP as the preferred salvage regimen for pts with relapsed/refractory DLBCL and HL since 2002. Patients and Methods:We conducted a retrospective analysis using the BCCA Lymphoid Cancer Database and included all pts with relapsed/refractory DLBCL and HL who received GDP as salvage therapy between September 2002 and June 2010. Pts were treated with gemcitabine 1000 mg/m2 IV day 1,8; dexamethasone 40 mg PO days 1–4 and cisplatin 75 mg/m2 IV day 1, administered at 3 week intervals (2-3 cycles for transplant eligible patients and up to 6 cycles for non-transplant candidates). Primary endpoints were response rate, PFS (defined as the interval from the beginning of GDP to first progression, relapse or death from any cause) and OS. Results:235 pts treated with GDP were identified; 152 and 83 pts with relapsed/refractory DLBCL and HL, respectively.Clinical characteristics at time of diagnosis for patients with DLBCL were: 68% male, 65% stage III/IV, 42% bulky disease ≥ 10 cm, 43% B-symptoms, 59% IPI 0–2, 41% IPI 3–5. Median age at time of GDP was 57 y (range 20–79 y). 57 pts (37%) had primary refractory disease to first-line R-CHOP; 144 (95%) were treated with GDP at first relapse/progression; median time from diagnosis to relapse after R-CHOP (excluding primary refractory pts) was 21 m (range 7–139 m). 30 pts (20%) received rituximab with GDP. Detailed radiologic response assessment following GDP(+/−R) was available for 82% pts with response rates as follows: 16% CR/CRu, 33% PR, 17% SD, 34% PD. 9 pts (6%) underwent HDC followed by allogeneic SCT and 57 pts (38%) underwent HDC followed by autologous SCT. With median follow-up of 24 m from start of GDP (range 0–84 m), 51 pts (34%) were alive and 101 pts (66%) have died (99 from lymphoma, 1 treatment toxicity during allogeneic SCT, 1 unrelated cause). 2-y PFS and OS were 21% and 28%, respectively. The 2-y PFS and OS for the subset of patients who underwent HDC/SCT were 36% and 47%, respectively.Clinical characteristics at diagnosis for the 83 pts with relapsed/refractory HL were: 55% male, 59% stage III/IV, 39% bulky disease ≥ 10 cm, 55% B-symptoms, 80% nodular sclerosis, 4% mixed cellularity, 2% nodular lymphocyte predominant, 2% lymphocyte depleted and 12% HL NOS. IPS variables were retrievable on 66% patients: 82% IPS ≤ 3 and 18% IPS ≥ 4. Median age at time of GDP was 31 y (range 17–73 y). 30 pts (36%) had primary refractory HL and 73 (88%) received GDP at first relapse/progression. Median time from diagnosis to relapse following ABVD-like therapy (excluding primary refractory pts) was 20 m (range 9–186 m). Detailed radiologic response assessment following GDP was available in 67% pts with response rates as follows: 7% CR/CRu, 64% PR, 13% SD, 16% PD. In total, 1 pt underwent HDC followed by allogeneic SCT and 69 pts (83%) proceeded to HDC and autologous SCT. With a median follow-up of 30 m from start of GDP (range 0–86 m), 70 pts (84%) were alive and 13 (16%) have died (all from HL). 2-y PFS and OS were 58% and 85%, respectively, and for the subset of pts who underwent HDC/SCT were 57% and 86%, respectively. Hospitalization rates due to complications during GDP were higher in patients with DLBCL than HL (20% vs 7%), likely reflecting differences in age and co-morbidities between the 2 cohorts. No failures of stem cell mobilization were recorded and the only toxic death was a consequence of HDC and allogeneic SCT. Conclusions:GDP is an effective and well-tolerated out-patient salvage regimen for relapsed/refractory DLBCL and HL. Outcomes appear to be comparable to those reported with more aggressive regimens. Results from an ongoing Canadian prospective trial comparing R-GDP to R-DHAP will help clarify the role of GDP in the treatment of relapsed/refractory DLBCL. Disclosures:Connors:Hoffmann-La Roche: Research Funding.

A Population-Based Analysis of the Frequency of Anemia and Its Management before and during Chemotherapy in Patients with Malignant Lymphoma.

In patients with hematologic malignancies, chemotherapy has the potential to further suppress bone marrow production. While measures to correct anemia including transfusion and growth factor support can improve patients' function and quality of life, the intervention threshold and the methods of correcting anemia among clinicians managing patients with malignant lymphoma are not clear. The present study evaluates the frequency, severity and corrective interventions for anemia used before and during the delivery of the four most common chemotherapeutic regimens used at the BC Cancer Agency to treat patients with Hodgkin's and Non-Hodgkin's Lymphoma. A retrospective, electronic chart review was conducted of 316 patients who received cytotoxic chemotherapy for lymphoma at four BC Cancer Agency centers from June 1, 2004 to December 31, 2005. Initial hemoglobin (Hgb) and dates of first Hgb in the ranges, 110–119g/L, 100–109g/L, 90–99g/L and <90g/L were recorded. Review of medical records was performed to document the frequency of anemia-associated symptoms including fatigue and the frequency of any discussion or delivery of interventions for anemia (transfusion, epoetin [EPO] or both). In this study cohort, 23% of patients had Hodgkin's and 77% had Non-Hodgkin's disease. The proportions of male and female patients were 55% and 45%, respectively. The chemotherapy regimens delivered were: Doxorubicin, Cyclophosphamide, Vincristine and Prednisone (CHOP) in 24 patients, CHOP + Rituximab (CHOP-R) in 215 patients, Adriamycin, Bleomycin, Vinblastine, Dacarbazine (ABVD) in 73 patients, and Gemcitabine, Dexamethasone and Cisplatin (GDP) in 4 patients. Median age was 57 years (range 16–87 years). Prior to starting chemotherapy, 33% of subjects had a Hgb<120g/L and 7% subjects had a Hgb <100g/L. In patients with Hgb <100g/L prior to chemotherapy, fatigue was documented in 67% but intervention for Hgb <100g/L pre-chemotherapy occurred in only 10% of patients. Overall (before and during chemotherapy), the proportion of subjects with at least one Hgb<120g/L was 67%, <110g/L was 41%, <100g/L was 23% and <90g/L was 10%. Table 1 summarized anemia-related symptoms and interventions during chemotherapy delivery. Discussion and intervention rates increased as Hb declined, particularly at levels <90g/L. Among 32 patients with Hgb<90g/L, symptoms were documented in 23 patients. Transfusion was used in 23 patients and EPO was used in 1 patient. In conclusion, anemia was relatively common prior to and during chemotherapy for patients with malignant lymphoma. The threshold of anemia intervention during chemotherapy was Hgb <90g/L with transfusion as the predominant method used. Pre-chemotherapy intervention rates for anemia were low even in the presence of symptoms and at Hgb values where randomized trials have shown that intervention can improve fatigue and quality of life.Anemia-related symptoms and interventions during chemotherapy for patients with malignant lymphomaHgb Range (g/L)Number of casesSymptoms PresentInterventions Discussed but Not GivenTransfusion OnlyEPO onlyBoth Transfusion and EPO110–119137210000100–1099631100090–9959277400<90322302310