Peripheral T/NK cell lymphomas (PTCL) have a dismal prognosis with an overall 5 year survival < 30%. This drops to 21% and 6% for intermediate-high and high International Prognostic Index scores, respectively.

The incorporation of new agents and transplant procedures in upfront strategies is a significant challenge for clinicians because of the advanced age of the patient population and the unsatisfactory results achieved with anthracyclines- based standard or intensified regimens.

The nucleoside analog gemcitabine has shown high single agent activity in recurrent disease, but very little data are available on the upfront efficacy of gemcitabine-based combinations.

A dose-dense combination of gemcitabine (G) with ifosfamide (Ifo) and oxaliplatin (Ox) (GIFOX regimen), followed by SCs mobilisation and autologous transplantation (ASCT) resulted in an overall response rate of 86%, with 4 partial and 14 complete responses. Among the eight patients eligible for ASCT, 6 had an effective CD34+ cell harvest and 4 proceeded to transplant. The 5-year event-free survival was 49%, with a median survival of 30.5 months. For complete responders the probability of relapse was 36.5% at a median follow-up of 24 months.

It was concluded from this study that GIFOX retains an attractive therapeutic potential as an upfront strategy in PTCL, enabling cytoreduction and SCs mobilisation for ASCT consolidation, and provides the option of a full induction programme to patients who are older or unfit for high dose chemotherapy.

Reference

G Corazzelli, F Frigeri, G Marcacci et al Gemcitabine, Ifosfamide, Oxaliplatin (GIFOX) as First-Line Treatment In High-Risk Peripheral T Cell/NK Lymphomas: A Phase II Trial Abstract 2829 presented at 52nd ASH, Orlando, FL, December 4-7, 2010