High transplant conversion rates with gemcitabine, dexamethasone and carboplatin (GDP)-based therapy in Relapsed/Refractory lymphoma: A real-world experience

Abstract

Abstract Background Relapsed & refractory (R/R) disease imposes significant morbidity and mortality on lymphoma patients. Salvage chemotherapy to achieve complete remission (CR) followed by an Autologous Hematopoietic Cell Transplantation (auto-HCT), is a widely used approach for such patients. Most of the salvage therapies require hospitalisation, have complex administration protocols, and impose a substantial financial burden. Present study evaluated efficacy of Gemcitabine/Dexamethasone/Cisplatin (GDP) with/ without targeted agents as a salvage chemotherapy option prior to auto-HCT for R/R lymphomas. Aim To analyse the effectiveness of GDP-based chemotherapy, with or without targeted therapies, as a bridge to auto-HCT in patients with R/R Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL). Methods This single-center ambispective study included adult and pediatric patients with R/R HL and NHL. GDP chemotherapy (Gemcitabine on Days 1 & 8, Dexamethasone on Days 1–4, and Cisplatin or Carboplatin on Day 1) was administered in a three-week cycle, primarily in a daycare setting. Selected patients received additional targeted agents (Rituximab, Brentuximab Vedotin, Nivolumab). Response was assessed via whole-body PET-CT as per Lugano Classification1. Patients achieving adequate response underwent BEAM conditioning followed by auto-HCT. G-CSF and Plerixafor-mobilized peripheral blood stem cell were used in all patients. Adverse events were graded per CTCAE criteria. Cost analysis included drug costs, number of cycles, and daycare or hospitalization usage. Results Total of 28 patients with Relapsed/ Refractory lymphoma: 16 (58%) HL and 12 (42%) NHL received GDP based bridge to transplant. Eleven patients received Rituximab, 5 patients received Brentuximab Vedotin and 2 patients received Nivolumab along with GDP therapy. Total of 21(75%) patients underwent auto HCT. Eighty one percent of HL patients and 66% NHL patients underwent auto HCT. CR before transplant was seen in 76% patients and 24% had partial response. Average 2 cycles (Range 1-4) were required before transplant. CR before transplant was seen in 75% and 41% of HL and NHL patients respectively. Febrile Neutropenia was seen in 35%, and thrombocytopenia in 54% patients. Prophylactic/ therapeutic growth factor was required in 60% patients. Infective complications were seen in 39% and non-infective ones in 21% of patients. Average cost of GDP administration per cycle was INR 22,393 and that of median cycles required for achieving complete response was INR 44,786. Eligible patients received agents like Rituximab, Brentuximab, and Nivolumab with additional cost per cycle. Discussion The auto-HCT rate in this study (75%) aligns with reported literature (49–95%)2-9. As observed in previous studies, HL patients had higher CR and transplant rates than NHL patients. Notably, all patients receiving targeted agents proceeded to transplant, consistent with higher success rates (85–95%)2,3,6 reported elsewhere. Unlike most salvage therapies which have complex administration protocols and require 2-4 days of hospitalisation; most of the GDP based cycles were administered with ease on day care basis. Use of Carboplatin instead of Cisplatin does not require aggressive hydration, increasing ease of administration and shortens time duration. These benefits positively influenced patient quality of life and healthcare utilization. Conclusion GDP-based chemotherapy, with or without targeted agents, is an effective, cost-efficient, and patient-friendly salvage regimen for R/R lymphoma. It facilitates high CR and transplant rates—especially in HL—with manageable toxicity. The regimen's daycare feasibility and reduced hospitalization needs offer significant quality-of-life and economic advantages. Substituting Carboplatin for Cisplatin further enhances administration convenience.