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Results from a recent article published in the journal Blood indicate that treatment consisting of a specific multi-modality approach may improve survival for patients with recurrent B-cell NHL. A multi-modality approach augments anti-cancer effects by combining different anti-cancer therapies that destroy cancer cells through different methods. The combination of therapies evaluated in this clinical trial consisted of monoclonal antibody (I-131 Tositumomab) treatment, high-dose chemotherapy (HDC) and stem cell transplantation (SCT).

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 and lymph vessels which exist throughout the body. It is also present in organs such as the bone marrow, thymus, tonsils, and spleen. The main cells in the lymph system are lymphocytes, of which there are two types: B and T cells. Each of these cells has a very specific function in aiding the body to fight infection. The large majority of NHL cases involve cancer of the B-lymphocytes and are characterized by the excessive accumulation of these atypical cells. Sometimes this disease will be referred to as B-cell NHL or B-cell lymphoma. These cancerous cells can crowd the lymph tissue causing suppression of normal formation and function of the other immune or blood cells normally found in this tissue.

I-131 Tositumomab is a new therapy currently in development that has demonstrated significant anti-cancer activity against NHL in previous clinical trials. This treatment utilizes two separate strategies to target and kill cancer cells. I-131 is a radioactive substance that is linked to tositumomab, a monoclonal antibody. Monoclonal antibodies can be produced in a laboratory and are able to specifically identify cancer cells and attack them. Tositumomab binds proteins found only on the surface of cancerous B-cells. This binding stimulates the immune system to attack and kill the cancer cells. I-131 is a radioactive isotope that spontaneously emits forms of radiation. When tositumomab binds to cancer cells, the attached I-131 additionally destroys these cells by emission of its radiation. This type of treatment not only provides two separate treatment strategies, but also allows the delivery of greater amounts of radiation to the cancer cells while minimizing radiation exposure to normal cells.

Standard treatment of recurrent NHL consists of HDC and autologous which achieves a cure rate of approximately 50%. By combining I-131 tositomumab with this standard HDC, researchers from the University of Washington and the Fred Hutchinson Cancer Research Center hope to improve the cure rates of patients with this disease. A recent clinical trial was conducted evaluating the effectiveness and tolerability of a multi-modality approach in the treatment of patients with B-cell NHL who have recurrent cancer. The treatment consisted of I-131 tositomumab and HDC consisting of etoposide and cyclophosphamide, followed by an autologous.

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Two years following treatment, 83% of patients were still alive and 68% of these patients remained cancer free. These results appear slightly better than treatment utilizing standard high-dose therapy for patients with recurrent B-cell NHL. Results from this trial are important in facilitating the expansion of treatment options, which may ultimately improve survival for patients with this disease. Future clinical trials directly comparing the use of HDC alone to HDC plus I-131 tositomumab in patients with recurrent NHL are needed in order to confirm these results. Patients with recurrent NHL may wish to speak with their physicians about the risks and benefits of participating in a clinical trial utilizing this treatment approach or other promising therapies. Two sources of information that can be discussed with a doctor include comprehensive, easy-to-use services provided by the National Cancer Institute ( and also provides personalized clinical trial searches on behalf of patients. (Blood, Vol 96, No 9, pp 2934-2942, 2000)

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