For patients with NHL involving the brain or eye who have failed initial treatment, treatment consisting of high-dose chemotherapy with autologous stem cell infusion may improve survival over standard treatment, according to results from a study recently published in the Journal of Clinical Oncology.

Non-Hodgkin’s Lymphoma (NHL) 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 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, characterized by the excessive accumulation of these atypical cells. These cancerous cells can crowd the lymph tissue causing suppression of normal formation and function of other cells necessary for normal immune functions. Since lymphocytes are able to travel virtually anywhere in the body through blood or lymph vessels, lymphomas can occur outside of the lymph tissue in areas such as the brain or the eye.

Standard treatment for lymphoma that involves the brain or the eye typically consists of the chemotherapy combination of methotrexate and leucovorin plus whole-brain radiation therapy; however, more than half of patients will experience recurrence of their cancer following this treatment and will ultimately die from their disease. Additionally, whole-brain radiation therapy can cause considerable permanent and temporary side effects. Recent research efforts have focused on improving the effectiveness of chemotherapy regimens to treat NHL of the brain or eye in an attempt to increase survival rates and reduce side effects.

High-dose chemotherapy kills more cancer cells than standard chemotherapy; however, it also causes more damage to the blood cells, particularly those in the bone marrow. The bone marrow (and circulating blood) contains early blood-forming cells, called stem cells, which grow and mature into 3 blood cell types: white blood cells, which protect the body from infection; red blood cells, which carry oxygen to the tissues; and platelets, which help the blood to clot. When bone marrow is destroyed, stem cells are depleted, leading to low levels of circulating blood cells. When these cells reach critically low levels, complications such as anemia, bleeding and infection can occur which may result in death. Thus, it is imperative to restore stem cell levels as quickly as possible.

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A stem cell transplant is a procedure that replaces the stem cells that are destroyed by high-dose chemotherapy with healthy stem cells, thereby allowing more rapid recovery and production of the red blood cells, white blood cells, and platelets that the body needs. An autologous stem cell transplant uses stem cells collected directly from the blood or bone marrow of the patient prior to the delivery of the high-dose chemotherapy.

Recently, researchers in France conducted a study in 22 patients with refractory (12 patients) or recurrent (10 patients) NHL of the brain or the eye. All patients had failed initial treatment or relapsed after an initial remission. Following treatment with high-dose chemotherapy and an autologous stem cell transplant, 16 patients had complete disappearance of NHL, 2 remained in partial remission, 1 had stable disease, and 1 had disease progression. Fourteen patients remain alive with an average follow-up time of 42 months. The overall survival at 3 years was 64% and the survival without recurrence of NHL was 53%. Seven patients had neurologic complications of treatment.

The researchers concluded that high-dose chemotherapy with autologous stem cell transplant could potentially cure some patients with NHL of the brain and eye who had failed conventional chemotherapy. Patients with NHL of the brain or eye may wish to talk to their doctor about high-dose chemotherapy treatment with autologous stem cell support or other promising new treatments. Two sources of information on ongoing clinical trials that can also be discussed with a doctor include comprehensive, easy to use clinical trials listing services provided by the National Cancer Institute (cancer.gov) and eCancerTrials.com. eCancerTrials.com also performs personalized clinical trial searches on behalf of patients. (Journal of Clinical Oncology, Vol 19, No. 3, pp. 742-749, 2001)

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