Role of Gemcitabine, Oxaliplatin and Prednisolone Combination as First-Line Chemotherapy in Non-Hodgkin s Lymphoma

Non-Hodgkin s lymphomas (NHLs) are commonly treated with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP). The prognosis is disappointing for those 50% to 60% of patients who experience primary treatment failure or relapse after an initial response. So, identifying novel chemotherapeutic agents with activity against aggressive NHL is going on to improve existing combination regimens. Several encouraging trials were done to evaluate efficacy and safety of either gemicitabine or oxaliplatin as monotherapy or combined treatment in cases of refractory/relapsed NHL. The objective of the current study was to evaluate the efficacy and safety of gemcitabine, oxaliplatin and corticosteroids (GEMOX-P) as first-line treatment for patients with intermediate- high grade NHL. Patients and Methods: Thirty-three patients with intermediate/ high grade NHL were randomized into 2 groups. First group received standard (CHOP) with Prednisolone tablets 40 mg/m2/day for five days. The second group received (gemcitabine !000 mg/m² Dl, 8) then (oxaliplatin 80 mg/m2 DI) and (prednisolone tablets 40 mg/m²/day for five days) with recycling every 21 days. The primary end point was response rate. The secondary end points were disease-free survival and overall survival. Results: Evaluable cases were 33 patients (19 males: 14 females) with a median age of 53 years. Response rate in low risk patients was higher in (GEMOX-P) than (CHOP) as it formed (100% vs. 88. 9%) respectively (p 0.05). While in high risk patients, it was 66. 7% and 80% in (CHOP) and (GEMOX-P) groups respectively. Complete remission occurred in 16.7% and 46.7% in high risk cases of both treatment arms respectively (p 0.05). Disease-free survival and overall survival after 18 months did not show statistically significant difference in both treatment arms. Hematological, gastrointestinal tract toxicity and neurotoxicity were the main side effects in both treatment groups. Alopecia, cardiotoxicity and elevation of hepatic enzymes was higher in (CHOP) arm, while neurotoxicity and orthostatic hypotension was higher in (GEMOXP) arm. Conclusion: The regimen of (GEMOX-P) had beneficial effects over (CHOP) regimen that included higher complete response rate in high risk cases and lower cardiac and hepatic toxicity, but there was no difference after 18 months in diseasefree or overall survival between both treatment arms. Selection of cases that may benefit from chemotherapy treatment either (CHOP) or (GEMOX-P) is needed with balance between anticipated toxicities, treatment outcome and cost-benefit aspect.