Current role of gemcitabine in the treatment of Hodgkin lymphoma

Most patients with Hodgkin lymphoma (HL) can be cured with initial multiagent chemotherapy. About 20-30% of the patients, however, experience refractory or relapsed diseases, for which effective salvage treatment is needed. Recent studies have shown promising activity of gemcitabine, a pyrimidine analogue commonly used in solid tumors, also in HL. Single agent gemcitabine in relapsed or refractory HL produces overall response rate of about 40%. Even in post-transplant patients, response rate is about 20%. Combination regimens with other agents such as cisplatin, vinorelbine, doxorubicin, ifosfamide and steroid have also been evaluated for relapsed or refractory diseases. These regimens generally have favorable toxicity profile and overall response rate exceeds 70%. Gemcitabine containing regimens have also been evaluated in upfront setting for early stage HL. The regimens containing bleomycin and gemcitabine, however, are associated with clinically significant pulmonary toxicity in 30-42% of patients and thus not recommended for further evaluation. A bleomycin sparing regimen consisting of doxorubicin, vinblastine and gemcitabine produced insufficient response rate and is also not recommended as the first treatment. Further studies are needed to evaluate the optimal timing and combination of gemcitabine. Combination regimens with other novel target therapy agents are also of great interest.