An new study presented at the Congress of the European Hematology Association in Vienna (A) showed that survival rates are improved using intensive rather than conventional therapies. The results were so clearly in favor of intensive therapy that conclusions could be reached before the study was completed, Italian scientists reported in Vienna.
There are many forms of cancer of the immune system, known under the general term non-Hodgkin’s lymphoma, and follicular lymphoma, a cancer of the lymph nodes, “the police stations” of the body, is one of them. Lymphomas are uncommon diseases but follicular lymphoma is one of the commonest, and is often marked by enlarged lymph nodes, fever, and weight loss. An important study has just been carried out on the optimal treatment regimes for follicular lymphoma, looking at whether survival rates are improved using intensive rather than conventional therapies. The results were so clearly in favor of intensive therapy that conclusions could be reached before the study was completed.
There has been some uncertainty about whether using intensified chemotherapy and autologous stem cell transplantation (ASCT: transplantation of the patient’s own stem cells) in patients whose treatment also includes rituximab is the most appropriate treatment for severe cases of follicular lymphoma. The intravenous drug rituximab, an artificial antibody, causes tumor cells to disintegrate, and was used in combination with both conventional and intensive therapies under investigation. A study undertaken by 30 Italian institutions and presented by Dr Marco Ladetto at the 12th Congress of the European Hematology Association meeting in Vienna from 7 to 10 June 2007 shows remarkably clear results: intensive chemotherapy and ASCT in these cases improves disease-free survival rates by over 30%.
Follicular lymphoma can strike at any age and the study included patients in the age range 18 to 60. Patients entering the conventional chemotherapy arm who did poorly were allowed to be treated with the intensified arm regimen as salvage regimen and in 60% of cases were rescued. Molecular analysis of bone marrow cells was used to ascertain patient health status. Analysis of remission at the molecular level has not been available in any randomized study before. The study originally intended to include 240 patients. “The trial was stopped once analysis of 136 patients had been completed, because results were so dramatically clear”, says Dr Ladetto. “At a median of 39 months after treatment over 60% of patients who received intensive chemotherapy and ASCT are alive and well with no need of further therapy, as compared to just over 30% in those who received conventional therapies.”
Dr Ladetto’s study is the first randomized trial investigating intensified chemotherapy to be completed since the general introduction of rituximab. It clearly demonstrates that for those patients with severe cases of follicular lymphoma, intensive chemo-immunotherapy offers significantly better chances of long term remission.