Gemcitabine (21,21-difluorodeoxycytosine; Gemzar) is a deoxycytidine analogue that inhibits DNA synthesis and repair. GEM as a single agent has been utilized in
Table 15-19. Regimen of Ifosfamide (IF) and Vinorelbine (VRB) in Relapsed or Refractory Hodgkin Disease
IF 300 mg/m2/day Days 1-4 with MESNA 3000 mg/kg/day, day 1-5
G-CSF 5 ^g/kg/day starting on day 6 and until ANC >1500/mm3 for 3 days or the
• Next cycle is administered 21 days later (ANC >1000/mm3 after discontinuation of G-CSF and platelet count >75,000/mm3)
• Evaluation: If CR, peripheral stem cell harvest should be carried out after 2 cycles of IF/VRB. This should be followed by HSCT preparatory regimen (Chapter 25) and peripheral stem cell transplantation.
• Evaluation: If stable disease is attained and/or PR, peripheral stem cell harvest should be carried out followed by two more cycles of IF/VRB, HSCT preparatory regimen (cyclophosphamide, etoposide, and BCNU-CBV [Table 16-13] or BCNU, etoposide, Ara-C, melphalan-BEAM [Table 16-14]), and peripheral stem cell transplantation.
the treatment of patients who have relapsed or refractory HD. A response rate of 40% has been attained with GEM alone. There is an additive effect with GEM and VLB with little increase in toxicity. Combined GEM and VLB has produced disease stabilization or response in about 60% of cases. Table 15-20 shows a regimen of VRB and GEM therapy in relapsed or refractory HD.
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