Abstract P118

Gemcitabine and Vinorelbine as 3rd line Chemotherapy for Primary Refractory/relapsing Hodgkin Lymphoma-Outcome and Toxicity Profile

For patients with relapsed or primary refractory Hodgkin’s disease, the potential for cure remains approximately 50% with current therapies including high-dose chemotherapy and autologous hematopoietic stem cell transplantation (AHSCT).The aim of our study is to report the response rate and toxicity profile of the 3rd line chemotherapy Gemcitabine/Vinorelbine in primary refractory/relapsing HL. Patients and methods:A retrospective analysis including all patients who received Gemcitabine/Vinorelbine as 3rd line salvage chemotherapy following ABVD +/- radiotherapy as 1st line, and ICE as 2nd lines chemotherapy diagnosed and treated at the Children Cancer Hospital Egypt during 10 years period.

Results: Out of 700 patients registered between July 2007 and end of December 2017 116 patients relapsed or had a progressive disease (16.5%). Ninety-eight patients received ICE as second line chemotherapy. Thirty patients out of 116 failed second line and received third line., 4 patients were excluded from analysis as they received other type of chemotherapy (Navelbine/Ifosfamide), while 32 patients received Gemcitabine/Vinorelbine and were included in our study. They were 21 males (65.6%), and 11 females (34.4%). Mean age was 10.71 years, range 4.5-17.4 with standard deviation 3.69 years. The most common pathologic subtype was nodular sclerosis (62.5%), followed by mixed cellularity (21.9%). According to Ann Arbor staging, 1 patient (3.1%) was stage I, while 6 (18.7%) were stage II, 10 stage III (31.3%), and 15 (46.9%) stage IV.High risk patients were 21 (65.6%), intermediate risk 5 (15.6%), and low risk 6 (18.8%). Sixteen patients (50%) had late relapse (> 1 year), 8 (25%) early relapse (3 months-1 year), and 8 (25%) were progressive/refractory (less than 3 months). Chemotherapy cycles varied from 1 to 6 with a mean of 3 cycles. Thirteen patients (40.6%) were responders to Gemzar/Navelbine and underwent hematopoietic stem cell transplantation, while (59.4%) progressed and continued treatment on palliative basis.Eight patients (42.1%) died, 5 of them (62.5%) due to disease progression, and 3 (37.5%) out of chemotherapy toxicity. The 2 years overall survival for responding patients was 87.5%, for non-responders was 72%. Multivariate analysis included sex, risk stratification, type of relapse, stage and showed no significant association.Conclusion:Gemzar/Navelbine is safe to be given as 3rd line chemotherapy for relapsing or primary refractory HL.

Authors

Asmaa Hamoda, reham khedr, hany abdelrahman, naglaa elkinaii, iman zaki, engy mohamed