According to a recent article published in The Lancet, high-dose chemotherapy with autologous stem cell transplantation appears to improve outcomes compared to aggressive conventional chemotherapy for recurrent Hodgkin’s lymphoma.
Hodgkin’s lymphoma is a cancer of the lymph system, which is part of the immune (infection-fighting) system that includes blood vessels, bone marrow, lymph nodes and lymph vessels that are present throughout the body. It also includes organs such as the spleen, thymus and tonsils. This cancer is characterized by uncontrolled growth of atypical white blood cells (immune cells) that crowd lymph tissue, suppressing the formation and function of other cells normally found in this tissue. Hodgkin’s lymphoma usually begins in a single lymph node and is capable of spreading throughout the body.
High-dose chemotherapy followed by blood or marrow transplants is the current standard treatment for most patients with recurrent Hodgkin’s lymphoma. In an autologous stem cell transplant, stem cells are collected from either blood or bone marrow from the patient prior to therapy, stored and then infused into the patient following high-dose chemotherapy. This procedure replaces the patient’s own stem cells, which have been destroyed by the high-dose therapy, thereby allowing more rapid recovery and production of the red blood cells, white blood cells and platelets needed by the body.
Although high-dose chemotherapy and stem cell transplantation is considered the treatment of choice for patients with relapsed Hodgkin’s lymphoma, new chemotherapy agents and treatment schedules are continually evolving, necessitating reevaluation of standard therapies. Recently, the German Hodgkin’s Lymphoma Study Group (GHSG) and the Lymphoma Working Party of the European Group for Blood and Marrow Transplantation (EBMT) performed a clinical trial to directly compare high-dose chemotherapy and autologous stem cell transplantation to aggressive chemotherapy in patients with relapsed Hodgkin’s lymphoma. The trial included 144 patients with relapsed Hodgkin’s lymphoma who were first treated with two cycles of conventional-dose Dexa-BEAM (dexamethasone, carmustine (BCNU®), etoposide (VePesid®),cytarabine (Cytosar U®) and Alkeran® (melphalan)) chemotherapy. Patients were then treated with either two further courses of Dexa-BEAM (61) or high dose chemotherapy with BEAM (81) and an autologous stem cell transplant. Approximately three years following therapy, the rate of patients who died or had a cancer recurrence was only 45% for those treated with high-dose therapy, compared to 66% for those treated with the aggressive conventional-dose regimen. Overall survival was 71% for those treated with high-dose therapy compared to 65% for those treated with conventional therapy. Patients who had a cancer relapse following conventional-dose therapy were allowed to receive further treatment with the high-dose regimen and patients who had a relapse following high-dose therapy were allowed to receive treatment with additional chemotherapy regimens. Early deaths from treatment-related causes occurred in six patients who received conventional-dose therapy and only one patient who received high-dose therapy. However, late deaths due to treatment-related causes occurred in five patients treated with high-dose therapy, mostly due to re-treatment of cancer relapses after the high-dose therapy regimen.
These researchers concluded that high-dose chemotherapy and autologous stem cell transplantation provides superior outcomes to conventional-dose chemotherapy in patients with relapsed Hodgkin’s lymphoma. Longer follow-up will reveal long-term side effects of either treatment and may reveal differing survival rates. Patients with relapsed Hodgkin’s lymphoma may wish to speak with their physician about the risks and benefits of high-dose chemotherapy and a stem cell transplant or participating in a clinical trial evaluating other novel therapeutic approaches. Two sources of information regarding ongoing clinical trials include the National Cancer Institute (cancer.gov) and www.eCancerTrials.com eCancerTrials.com also provides personalized clinical trial searches on behalf of patients.
Reference: Schmitz, N, Pfistner B, Sextro M, et al. Aggressive conventional chemotherapy compared with high-dose chemotherapy with autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkin’s disease: a randomized trial.
The Lancet. 2002;359:2065-2071.
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