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Prognostic factors and efficacy of GDP-R therapy in refractory/relapsed diffuse large B-cell lymphomas not eligible for high-dose therapy Francesco Ghio1, Giulia Cervetti1, Nadia Cecconi1, Matteo Pelosini1, Sara Galimberti1, Riccardo Morganti2, Paola Ferrari1, Andrea Nicolini1, Mario Petrini1 1Department of Clinical and Experimental Medicine, University of Pisa, 67-56127 Pisa, Italy. 2Department of Oncology, University Hospital of Pisa, 67-56127 Pisa, Italy. Correspondence to: Dr. Francesco Ghio, Department of Clinical and Experimental Medicine, University of Pisa, 67-56127 Pisa, Italy. E-mail: francescoghio83@gmail.com Aim: The main aim of the present study was to evaluate the overall survival (OS) and time to treatment failure (TTF) in a cohort of relapsed/refractory diffuse large B-cell lymphomas (DLBCLs) not eligible for high-dose therapy (HDT) treated with gemcitabine in association with dexamethasone, cisplatin and rituximab (GDP-R) protocol. The secondary aim was to identify the prognostic factors impacting OS and TTF. Methods: The authors retrospectively analyzed 45 patients with refractory/relapsed DLBCLs treated with GDP-R. Results: Overall response rate (ORR) was 48.8%; complete response 15/45 (33.3%), partial response 7/45 (15.5%). Response was influenced by the number of previous therapies administered and International Prognostic Index (IPI) value. Although no significant impact occurred with regard to OS, patients pre-treated with 2 or < 2 chemotherapeutic regimens had better ORR (P = 0.014) and a longer TTF (P = 0.029 in multivariate Cox model). IPI value also influenced TTF. Patients with < 2 IPI value had significantly more prolonged TTF than the other ones (P = 0.048 in multivariate Cox model). Treatment was welltolerated, with the majority of patients treated on out-patient modality. GDP-R regimen represents a valid treatment for aggressive relapsed/refractory B-cell lymphoma not eligible for HDT thanks to its efficacy and good toxic profile. Conclusion: The number of previous chemotherapeutic regimens and IPI value select those who benefit more from this treatment.