Gentler chemo helps patients survive lymphoma
By Maggie Fox
WASHINGTON (Reuters) - A gentler chemotherapy regimen may help some lymphoma patients better tolerate and benefit from bone marrow transplants, and the combination could even cure them, U.S. doctors reported on Monday.
They said it is not necessary to destroy the immune systems of patients with follicular lymphoma in order to have a bone marrow transplant help -- and taking a more moderate approach may actually work better.
"There is no other treatment that can give you a cure for follicular lymphoma," Dr. Issa Khouri of the University of Texas M. D. Anderson Cancer Center, who led the study, said in a telephone interview.
"No other treatments produce this type of response," added Khouri, who presented his findings to a meeting in Atlanta of the American Society of Hematology.
Follicular lymphoma is one of several types of non-Hodgkin lymphoma, a cancer of the lymphatic system.
The usual treatment is a chemotherapy cocktail, but patients often relapse years afterwards.
For patients who have relapsed, doctors usually give them a very high dose of chemotherapy to kill the lymphoma cells and then do a bone marrow stem cell transplant. But this also shuts down the patient's own blood-producing stem cells.
It leaves patients vulnerable to infection, bleeding, and anemia in the five or so months it takes for the transplanted cells to grow.
Khouri's team tested 47 patients with follicular lymphoma that had relapsed after initial treatment, giving them a chemotherapy cocktail that did not completely destroy their immune systems, and including Rituxan, a targeted drug that has become a standard treatment for the lymphoma.
"It does not suppress the immune system for a long time," Khouri said. Then the patients were given bone marrow stem cell transplants
He said 40 of the patients lived five to nine years after treatment without a relapse. Two patients relapsed once more but another treatment controlled the cancer. Seven died of something other than lymphoma.
"Patients are active, doing their daily jobs. They are out and maintain a normal life," Khouri said.
Tests suggest the same approach works in another type of non-Hodgkin lymphoma called mantle cell lymphoma. This is a far more aggressive type, with a median survival of three years, but patients appear to be helped by the new approach, Khouri said.
The gentler approach would not work in leukemia, a different type of blood cancer, Khouri said.
"In leukemia cells the cells are dividing more rapidly and therefore they can overcome the low intensity. You have to use a more intense regimen," he said.
About 10,000 cases of follicular lymphoma are diagnosed every year in the United States. Just under 4,000 cases of mantle cell lymphoma occur in the United States every year.