According to results recently presented at the 43rd Annual Meeting of the American Society of Hematology, research indicates that an autologous stem cell transplant (ASCT) may be more effective than Interferon for the maintenance therapy of mantle cell non-Hodgkin’s lymphoma (NHL).
Non-Hodgkin’s lymphoma is a cancer of the lymph tissue, which is part of the body’s immune system. Lymph tissue is present in lymph nodes, lymph vessels and bone marrow, which exist throughout the body. It is also present in organs such as the thymus, tonsils and spleen. The main cells in the lymph system are called lymphocytes, of which there are 2 types: B and T-cells. Each of these cells has a specific function in aiding the body to fight infection. The large majority of NHL cases involve cancer of the B-lymphocytes, characterized by the excessive accumulation of these atypical cells. These cancerous cells can crowd the lymph tissue, thereby causing suppression of normal formation and function of other cells necessary for normal immune functions. While NHL is categorized by the type of lymphocyte it involves, it is also further defined by the specific appearance of the affected cells, as well the grade of the disease (how fast it is likely to grow). These determinations are based on how the cells look under a microscope. In terms of NHL grade, high-grade or aggressive NHL is the fastest growing. Mantle cell lymphomas are a high-grade, aggressive type of NHL, with average survival of less than 3 years and few long-term survivors.
Mantle cell lymphoma is a newly recognized type of lymphoma and subsequently, there is very little information regarding the appropriate treatment of this cancer. Most of the available information regarding the behavior of this cancer comes from looking at the treatment outcomes of patients that were re-classified as having mantle cell lymphoma long after their initial treatment. Re-analysis of patients treated with mantle cell lymphomas, however, suggests that this cancer is highly aggressive and extremely difficult to cure.
High-dose therapy followed by autologous stem cell transplantation has been the focus of some clinical trials evaluating treatment for mantle cell NHL. High-dose therapy utilizes high doses of agents like chemotherapy and/or radiation that are used to destroy cancer cells. However, these high doses also destroy normal cells, especially the blood producing stem cells in the bone marrow, resulting in complications such as anemia, infection and bleeding. The treatment strategy utilizing stem cell transplantation is an attempt to restore the blood producing stem cells after high-dose therapy has reduced them to dangerously low levels. During an autologous stem cell transplant, the patient’s own stem cells are collected from circulating blood before chemotherapy treatment, frozen, and infused back into the patient after treatment to rescue the bone marrow.
Researchers in Europe recently conducted a clinical trial directly comparing the efficacy of high-dose radiation plus chemotherapy (radiochemotherapy) followed by an ASCT to treatment with Interferon (a substance that stimulates the immune system to attack the cancer) as consolidation therapy for mantle cell NHL. In this clinical trial, 102 patients over the age of 65 with mantle cell NHL had achieved a partial or complete disappearance of their cancer following initial therapy. They were then treated with either high-dose radiochemotherapy plus ASCT or interferon. Up to 4 years following treatment, cancer recurrences occurred in only 17% of patients treated with the ASCT, compared with 53% of patients treated with Interferon. Although there was no final analysis of the impact of each treatment option on overall survival, researchers are hopeful that these results will ultimately translate into improved survival for patients treated with an ASCT utilizing high-dose radiochemotherapy following initial therapy. In addition, both treatment options were generally well tolerated More research is warranted to further define the role of this and other experimental approaches to the treatment of mantle cell NHL.
Patients with mantle cell NHL may wish to speak with their physician about the risks and benefits of participating in a clinical trial further evaluating the efficacy of myeloablative therapy followed by ASCT and other novel approaches. Two sources of information regarding ongoing clinical trials include comprehensive, easy-to-use listing services provided by the National Cancer Institute (
eCancerTrials.com. eCancerTrials.com also provides personalized clinical trial searches on behalf of patients. (
Proceedings from the 43rd Annual Meeting of the American Society of Hematology, abstract # 3572, Orlando, Florida, December 11-14, 2001)
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