Gemcitabine, carboplatin, and dexamethasone as salvage chemotherapy for outpatients with relapsed or refractory lymphoma

Background: Salvage chemotherapy for patients with relapsed or refractory lymphoma mostly requires admission, but the optimal regimen has not been established. Recently, gemcitabine, carboplatin, and dexamethasone (GCD) combination was introduced as salvage chemotherapy. Herein, we investigated the efficacy and feasibility of this combination for outpatients. Methods: We retrospectively analyzed outpatients with relapsed or refractory lymphoma treated with GCD plus rituximab (+R) as salvage chemotherapy in our institution between July 2014 and October 2017 (1000 mg/m2 gemcitabine on days 1 and 8, carboplatin at an area under the curve 5 on day 1, and 40 mg oral dexamethasone on days 1-4; for CD20-positive B-cell lymphoma, 375 mg/m2 rituximab was added). The response rate, adverse events, progression-free survival (PFS) and overall survival (OS) rates were estimated. Results: Twenty-one patients (diffuse large B-cell lymphoma, 14; peripheral T-cell lymphoma, NOS, 2; classical Hodgkin lymphoma, 3; follicular lymphoma, 1; and mantle cell lymphoma, 1) received GCD (+R) chemotherapy during the study period. The median patient age was 66 (21-83) years. The median number of prior regimens was 1 (1-2). The median number of courses was 4 (1-6). The overall response rate (complete + partial responses) was 71.4%. The median follow-up duration was 16.3 (2.0-44.1) months. Estimated 1-year PFS and OS rates were 57.1% and 73.3%, respectively. Grade 3 and 4 hematologic toxicities were observed in 3 (14.4%) and 13 (61.9%) patients, respectively. Fourteen (66.6%) and 8 (38.1%) patients received platelet and red blood cell transfusions, respectively. Thirteen (61.9%) patients received granulocyte colony stimulating factor support; febrile neutropenia was observed in 1 (4.8%) patient. There were no grade 3-4 non-hematologic adverse events and no treatment-related deaths. Conclusion: GCD (+R) is safe and effective for outpatients with relapsed or refractory lymphoma.