ESHAP versus GEMOX in Management of Relapsed or Refractory Lymphoma: A Prospective Randomized Study

Document Type : Original Article

Authors

1 Clinical Oncology Department, Kasr Al-Ainy Center of Clinical Oncology and Nuclear Medicine, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt

2 Nuclear Medicine Department, Kasr Al-Ainy Center of Clinical Oncology and Nuclear Medicine, Kasr Al-Ainy School of Medicine,Cairo University, Cairo, Egypt

Abstract

Background: There is lack of evidence about the best chemotherapy regimen in treatment of relapsed/refractory Hodgkin's
lymphoma (HL) and aggressive non-Hodgkin’s lymphoma (NHL) lymphoma.
Aim: To compare GEMOX (gemcitabine, oxaliplatin) with ESHAP (etoposide, methylprednisolone, cytarabine arbinoside,
cisplatin) regimes as 2nd line in lymphomas.
Methods: This was a prospective randomized study that included relapsed/refractory HL and aggressive NHL patients
who failed 1st line chemotherapy. After assessment for eligibility, patients were randomized to receive GEMOX or
ESHAP.
Results: The study included 41 patients, 21 of them received GEMOX and 20 received ESHAP. The response rate did not
differ significantly between the GEMOX and ESHAP arms (28.6% vs. 35%, p=0.793) as well as progression free survival
(8.7 months vs. 6.6 months, p=0.711). By univariate analysis for the whole group, the response rate differed significantly
according to disease status at relapse, time to relapse, lactate dehydrogenase, International Prognostic Index (IPI) and
secondary age-adjusted IPI (2ry aa-IPI). Hematological toxicity was not statistically different between the two treatment
arms. GEMOX was associated with significantly less vomiting of any grade (p=0.013). Acute renal toxicity of any grade
was significantly lower in GEMOX compared to ESHAP (p=0.003). In terms of peripheral neuropathy, GEMOX was
associated with significantly higher all grades (p=0.0001).
Conclusion: The current study results suggest that the response rate and progression free survival of GEMOX and ESHAP
are comparable with different toxicity profile.

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