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.