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

Abstract

Background: There is lack of evidence about the best chemotherapy regimen in treatment of relapsed/refractory Hodgkin'slymphoma (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 patientswho failed 1st line chemotherapy. After assessment for eligibility, patients were randomized to receive GEMOX orESHAP.Results: The study included 41 patients, 21 of them received GEMOX and 20 received ESHAP. The response rate did notdiffer 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 significantlyaccording to disease status at relapse, time to relapse, lactate dehydrogenase, International Prognostic Index (IPI) andsecondary age-adjusted IPI (2ry aa-IPI). Hematological toxicity was not statistically different between the two treatmentarms. GEMOX was associated with significantly less vomiting of any grade (p=0.013). Acute renal toxicity of any gradewas significantly lower in GEMOX compared to ESHAP (p=0.003). In terms of peripheral neuropathy, GEMOX wasassociated 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 ESHAPare comparable with different toxicity profile.

Keywords

• relapsed/refractory lymphoma
• gemox
• eshap