Rituximab Enhances Chemotherapy in Lymphoma Patients

In young and relatively young lymphoma patients, addition of the monoclonal antibody, rituximab, to standard chemotherapy improves survival, researchers report in an April 5th online edition of The Lancet Oncology.

Dr. Michael Pfreundschuh of Saarland University Medical School, Hamburg, Germany and colleagues note that rituximab along with cyclophosphamide, doxorubicin, vincristine and prednisolone (CHOP)-like chemotherapy has proved successful in elderly patients.

To investigate whether this might also be the case in those aged 18 to 60 years, the researchers studied 824 such patients with good-prognosis CD20-positive diffuse large B-cell lymphoma.

They were randomized to 6 cycles of CHOP-like chemotherapy with or without rituximab. Bulky and extranodal sites were treated with radiotherapy.

Three-year event-free survival rates were 79% among patients in the combination group, versus 59% of those given CHOP alone. For overall survival, the corresponding rates were 93% and 84%.

In the CHOP group there were 57 lymphoma-associated and one treatment-related death. In the combination group, there were 19- lymphoma-associated and 6 treatment-related deaths.

An age-adjusted International Prognostic Index (aaIPI) score of zero and lack of bulky disease was associated with a better prognosis than was the case for those without either or both of these favorable factors.

Dr. Pfreundschuh told Reuters Health that "while the results of the very favorable subgroup... can hardly be improved any further, the results in the less favorable subgroup -- all patients with aaIPI=1, and patients with aaIPI=0 and bulky disease -- definitely need further improvement."

Nonetheless, say the investigators, the effect of rituximab overall was greater than that expected on the basis of the earlier results in elderly patients. In fact, the team concludes that the need for salvage therapy in these younger patients "could be halved by the addition of rituximab."

Patients with Stage IV Follicular Lymphoma are Living Longer

Researchers at the M.D. Anderson Cancer Center in Texas evaluated trends over time in the survival of patients with stage IV follicular lymphoma; they found that survival improved notably between 1972 and 2002.

Non-Hodgkin’s lymphoma (NHL) is a form of cancer that begins in the cells of the lymph system. The lymph system includes the spleen, thymus, tonsils, bone marrow, lymph nodes, and circulating immune cells. The main cells in the lymph system are lymphocytes, which exist in two forms: B and T-cells. Each of these cells has a specific function in fighting infection.

NHL is characterized by the excessive accumulation of atypical (cancerous) lymphocytes. These lymphocytes can crowd the lymph system and suppress the formation and function of other immune and blood cells. NHL is categorized by the type of lymphocyte it involves and by the rate at which the cancer grows—both are determined by the cells’ appearance under a microscope.

Follicular lymphoma is considered a low-grade or indolent lymphoma, which means that it is a slow-growing subset of NHL. Although patients with advanced follicular lymphoma may survive for many years, the disease is generally considered incurable.

Because treatment of follicular NHL has evolved, researchers at the M.D. Anderson Cancer Center in Texas evaluated how survival has changed over time. They assessed 580 patients who were treated for stage IV follicular lymphoma between 1972 and 2002. Treatment varied during this period. Patients in the most recent time period (1997 to 2002) were treated with FND (fludarabine, mitoxantrone, and dexamethasone) with concurrent or sequential rituximab followed by interferon.

Researchers observed improved survival over time:

Between 1972 and 2002, the proportion of patients surviving for at least five years increased from 64% to 95%.
The proportion of patients surviving for at least five-years without lymphoma relapse or progression increased from 29% to 60%.
The researchers conclude that newer approaches to treatment have resulted in improved survival among patients with stage IV follicular lymphoma.

Reference: Liu Q, Fayad L, Cabanillas F et al. Improvement of Overall and Failure-Free Survival in Stage IV Follicular Lymphoma: 25 Years of Treatment Experience at the University of Texas M.D. Anderson Cancer Center. Journal of Clinical Oncology . 2006;24:1582-1589.

Elderly Patients with Non-Hodgkin’s Lymphoma Tolerate Autologous Stem Cell Transplantation

According to an article recently published in Bone Marrow Transplantation, elderly patients with non-Hodgkin’s lymphoma are able to tolerate autologous stem cell transplantation. However, it is important for all patients to discuss their individual risks of stem cell transplantation with their physician.

Non-hodgkin’s lymphoma (NHL) originates in the immune cells. There are several different types of NHL; each is categorized according to the specific cell from which the cancer originates, as well as specific characteristics of the cancer cells. Intermediate grade NHL refers to NHL that is moderately aggressive in nature.

Stem cell transplantation is a commonly used treatment for NHL, particularly intermediate or aggressive NHL. This procedure includes the use of high doses of therapy to kill more cancer cells than standard doses. However, the high doses also destroy normal cells, such as blood cells. The destruction of blood cells, particularly immune cells, red blood cells, and platelets, can lead to life-threatening side effects.

To compensate for the low and dangerous levels of blood cells following high-dose therapy, patients receive hematopoietic stem cells, or immature blood cells. These stem cells mature into the three types of blood cells. In an autologous stem cell transplant, the patient’s own stem cells are collected prior to high-dose therapy and then re-infused following therapy.

Elderly patients are perceived to not be able to tolerate the high doses of therapy as well as their younger counterparts. However, results from several clinical trials have recently demonstrated that elderly patients often benefit from the same types of therapy as younger patients; age alone should not be a deciding factor in choosing a treatment.

Researchers from the Mayo Clinic recently evaluated outcomes of patients with intermediate-grade NHL who were treated with autologous stem cell transplantation. The study included a review of data from 93 patients aged 60 years or older (24 were older than 70 years) who received an autologous stem cell transplant between 1995 and 2003 at the Mayo Clinic. Their outcomes were compared to younger patients with the same disease who were also treated with an autologous stem cell transplant.

Treatment-related mortality was 5.4% for older patients; this was not significantly different from younger patients (2.2%).
The median survival was 25 months in the older group compared with 56 months for younger patients.
Survival without cancer relapse was 38% at four years for the older patients compared with 42% in younger patients.
The only factor found to influence survival in the older group was the age-adjusted International Prognostic Index (variables regarding age and disease characteristics that are taken together to determine a patient’s prognosis).
The researchers concluded that elderly patients with intermediate-stage NHL derive benefit from autologous stem cell transplantation, particularly those with a good prognosis. It is important for elderly patients to speak with their physician regarding their individual risks and benefits of stem cell transplantation.

Reference: Baudi F, Micallef I, Ansell S, et al. Autologous Hematopoietic Stem-Cell Transplantation for Older Patients with Relapsed Non-Hodgkin's Lymphoma. Bone Marrow Transplantation. Early online publication April 24, 2006. doi: 10.1038/sj.bmt.1705371.

Acupuncture May Control Vomiting after Chemo

Acupuncture, in conjunction with the latest drugs to prevent nausea and vomiting, seems to help relieve chemotherapy-induced vomiting, a new report suggests.

Despite the advent of new drug that control nausea and vomiting related to chemotherapy (anti-emetics), many cancer patients still experience these unpleasant side effects, which can impair quality of life, cause emotional distress, and aggravate cancer-related symptoms such as weight loss, lethargy and weakness.

The ancient Chinese technique of acupuncture, used to treat a variety of ailments by stimulating specific points on the body, has become increasingly popular for chemotherapy-induced nausea and vomiting, based on what the National Institutes of Health recently called "promising" research.

The current findings are based on pooled data from up to 11 trials that looked at the impact of acupuncture-point stimulation on chemotherapy-induced nausea and vomiting in more than 1,200 cancer patients.

The studies looked at several different types of acupuncture, including electroacupuncture, in which a small electrical current is passed through very thin needles that penetrate the skin; noninvasive electrostimulation of the skin surface using a wristwatch-like device; manual acupuncture -- the most well-known type that involves insertion and manual rotation of very fine needles; or acupressure, which involves pressing on the points usually with fingertips.

According to investigators, 22 percent of patients who underwent acupuncture experienced vomiting the first day after chemotherapy compared with 31 percent of those who did not undergo acupuncture.

Co-author of the report, Jeanette M. Ezzo, of James P. Swyers Enterprises, a Baltimore-based company that develops complementary and alternative medicines, and associates also found that electroacupuncture reduces first-day vomiting, whereas noninvasive electrostimulation of the skin surface does not.

Manual acupuncture also appears to be largely ineffective for chemotherapy-induced nausea or vomiting.

Acupressure, the team found, reduces first-day nausea, but is not effective for "delayed" symptoms of nausea or vomiting.

In all of the trials included in the analysis, patients received concomitant anti-emetics, and all patients, except those in the electroacupuncture trials, received "state-of-the-art" drugs such as Zofran and Anzemet, which are currently recommended for chemotherapy-related nausea and vomiting.

Therefore, it's not known if electroacupuncture adds anything to the most current anti-emetic drugs. This is an important unknown that needs to be studied, note the investigators.

This review, published in the current issue of The Cochrane Library, complements data on post-operative nausea and vomiting suggesting that acupuncture has a biologic effect, Ezzo and colleagues conclude.

Atypical Lymphoid Tissue Lymphoma May Respond to Antibiotics

Antibiotic treatment may be effective for patients with early stage gastric mucosa associated lymphoid tissue (MALT) lymphoma, but are negative for Helicobacter pylori, Austrian researchers report in the May issue of Gut.

In most patients, MALT is associated with H. pylori infection, Dr. Markus Raderer of the Medical University Vienna and colleagues report. This has led to the use of antibiotics to eradicate the pathogen and to obtain generally good results.

The researchers determined if this approach could be effective in H. pylori-negative patients with MALT lymphoma restricted to the stomach. Six patients were treated with clarithromycin, metronidazole and pantoprazole.

After 3 to 9 months of treatment, five of the six patients showed lymphoma regression. There were four complete responses and one partial remission. The remaining patient had stable disease and was referred for chemotherapy at 12 months.

Follow-up at 19 months showed that all patients were alive and four continued to have a complete response.

"These findings," Dr. Raderer told Reuters Health, "might point to as yet undetected bacterial agents or additional immunological findings in the antibiotics used which have not been elucidated so far."

Nevertheless, given these results, he concluded that "H pylori-negative patients with stage I MALT lymphoma should have the chance of initial treatment with antibiotics."

Polio Vaccine Not Tied to Non-Hodgkin Lymphoma

Norwegian researchers report finding no support for the proposed link between a polio vaccine possibly contaminated with simian virus 40 (SV40) and lymphoproliferative diseases, including non-Hodgkin's lymphoma (NHL) and excluding Hodgkin's lymphoma.

The vaccine was administered between 1955 and 1963 around the world. Dr. Guri Olsen Thu and colleagues at the Cancer Registry of Norway, Montebello, Oslo, investigated the proposed link between vaccine and NHL by examining Norwegian cancer incidence data, looking at birth cohorts that the researchers assumed received the vaccine in question.

Between 1953 and 1997, the incidence of lymphoproliferative diseases tripled for both males and females. This increase was primarily due to an increase in cases of NHL.

Dr. Thu's group analyzed the data according to age, cohort and time period. "The cohort effect was more prominent than the period effect," they report in the April 15th International Journal of Cancer.

"However," the investigators conclude that "the variations in incidence patterns across the birth cohorts did not fit with the trends that would be expected if a SV40-contaminated vaccine did play a causative role" in the increase in lymphoproliferative diseases.