الفهرس 
Gemcitabine and Vinorelbine versus ICE Regimen in Treating Pediatric Patients with Recurrent or Primary Refractory Hodgkin’s Lymphoma
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Abstract
Background and aims: Pediatric Hodgkin lymphoma (HL) is a curable disease; however,the optimal salvage regimen is unclear for relapsed or refractory (R/R) disease. This study aimed to compare the response rate, toxicity, overall survival (OS), and event-free survival (EFS) of GV with ICE regimen after first-line ABVD (Doxorubicin-Bleomycin-Vinblastine-Dacarbazine) in patients with R/R HL.
Patients and Methods: This retrospective study included 132 pediatric patients with R/R HL (median age 13.9 years) treated from July2012 to December 2020 with GV (n=50) or ICE (n=82).
Results: The overall response rate (ORR) before consolidation was 54.3% to ICE and 28.6% to GV (P=0.011).Factors predicting poor ORR were a refractory disease (RD) during first-line, higher stage, female sex, age ≥13 years, B-symptoms, ESR ≥50 mm/h, WBC ≥13.5x109/L, Hgb<10.5 gm/dL. On multivariate analysis, only RD during first-line or early relapse (P=0.002), and B-symptoms (P=0.002) were independent factors to lowerORR.
Treatment-related mortalities were 2.4% for ICE and 2% for GV (P=0.86). Of the 389 ICE and 235 GV cycles given, grade 3/4 neutropenia, grade 3/4 thrombocytopenia, and grade 3 anemia were more frequent in ICE (96.6%, 82%, and 69.4% respectively) than GV regimen (18.7%, 4.6%, and 8% respectively) (P<0.0001). Fever neutropenia necessitating hospital admission occurred in 54.2% of ICE cycles compared with 2.1% of GV (P<0.0001) and clinically documented infections in 17.5% vs 2.1%, respectively (P<0.0001). Grade-3 hypokalemia, hypomagnesemia, hemorrhagic cystitis, blood-stream infection, and septic shock were reported in 28.7%, 26.2%, 8%, 4.8%, and 5.6% of ICE cycles, but none in GV. The 3-year OS was 69.3±10.6% for ICE and 74±12.9% for GV (P=0.3); while the 3-year EFS was 39.3±11.4% and 24.9± 12.5%; respectively (P=0.001).On multivariate analysis, regimen (P=0.0001), time to relapse (P=0.011), B symptoms (P=0.001), and WBC count (P=0.007), were significant for EFS, while hemoglobin level (P=0.008), and early response to 2nd line (P=0.022), were significant for OS to whole cohort.
Conclusions: TheICE regimen had a better response rate and EFS, but a higher toxicity profile than GV. However, OS and toxic mortality were similar for both regimens.