Non-Hodkin’s Lymphoma – Good News

Advances in Treatment for Aggressive Disease

Breaking News from ESMO, Nice.

Thursday 17th October saw a symposium on treatment of Non Hodkin’s Lymphoma which has not responded to initial treatment or which has relapsed soon into treatment.

This interesting day focused on the difficult problem of relapsed lymphomas. Generally speaking, approximately 40 percent of non-Hodgkin’s lymphomas are cured by chemotherapy. Of the others, a proportion will not respond to initial treatment (refractory disease) and the rest will relapse.

Treatment of these groups has previously been difficult. The workshop focused on the use of two relatively new drugs, ifosfamide and MabThera (rituximab). These treatments can be used to reduce the amount of lymphomatous tumour cells to a minimum so that autologous bone marrow transplantation (ABMT) – sometimes referred to as bone marrow transplant (BMT) or autologous stem cell transplant ASCT can then take place. It is known that up to 30% of people who relapse may still be cured with 2nd line (salvage) chemotherapy followed by ASCT.

In the ideal situation, the treatment must be effective (ie the lymphoma cells must be sensitive to the chemotherapy) with minimal toxicity to other organs and must not be toxic to the cells which are harvested for the bone marrow transplant (stem cells).

The first speaker was Dr Craig Moskowitz from the Lymphoma Service of the Memorial Sloane Kettering Cancer Centre, in the United States. He looked at a combination of ifosfamide, carboplatin and etoposide (called ICE) followed by ASCT.

He first reviewed the current evidence which impaired a standard chemotherapy with DHAP versus high dose therapy (HDT) and ASCT. A response occurred approximately twice as frequently (55%) in the bone marrow transplant group (Parma study).

Dr Craig Moskowitz then presented the data from an ongoing trial which he is involved with, which is treated 430 patients so far. These patients received ICE and if a good response occurred, they received radiotherapy to the involved sites (or total body irradiation if they were less than 60 years old). 72% of patients responded (85% of relapsed patients, 57% of refractory patients).

He concluded that ICE for relapsed disease was markedly better than previously available treatments such as DHAP or CHOP. Most importantly, only 3% of patients stopped treatment with ICE because of toxicity. Two-thirds of these patients developed reversible confusion which disappeared when treatment was ceased.

More news to follow later today.