Initial High-Dose Chemotherapy Improves Survival in Aggressive NHL
According to a recent article published in The New England Journal of Medicine, initial therapy with high-dose chemotherapy and an autologous stem cell transplant improves survival over conventional chemotherapy in aggressive non-Hodgkin’s lymphoma.
Non-Hodgkin’s lymphoma (NHL) is a type of cancer that affects the immune, or lymph system. There are several types of NHL, with aggressive NHL referring to cancer that is the fastest growing. High-dose therapy and an autologous stem cell transplant is a common type of treatment for different types of NHL. This treatment approach utilizes high doses of chemotherapy and/or radiation therapy, which may be more effective at killing cancer cells than lower doses; however, the higher doses also are associated with greater side effects. A common side effect caused by high-dose therapy is low levels of blood cells – white blood cells that help fight infection, red blood cells that deliver oxygen to tissues, and platelets that help the blood to clot. An autologous stem cell transplant utilizes the patient’s stem cells, which are immature blood cells, to restore levels of low blood cells caused by treatment. The stem cells are collected prior to high dose therapy, frozen, and re-infused following treatment.
Researchers may use high-dose therapy with stem cell transplant as initial therapy for patients with aggressive NHL, or utilize the treatment approach after a patient experiences a cancer recurrence following standard chemotherapy. One standard chemotherapy regimen utilized for initial treatment of aggressive NHL is referred to as CHOP, and includes the chemotherapy agents cyclophosphamide, doxorubicin, vincristine, and prednisone.
Researchers from France recently conducted a clinical trial to directly compare treatment with high-dose chemotherapy and an autologous stem cell transplant to CHOP in patients with aggressive NHL. This trial included 207 patients who had not received prior treatment and were treated with either high-dose chemotherapy/autologous stem cell transplant or CHOP. Cancer progression and/or a lack of an anti-cancer response occurred in only 13% of patients treated with high-dose therapy, compared to 27% of patients treated with CHOP. Five years following the initiation of treatment, progression-free survival was approximately 55% in the group of patients treated with high-dose therapy, compared to only approximately 37% in the group of patients treated with CHOP. Overall, there was a trend of increase in overall survival for patients treated with high-dose therapy compared to those treated with CHOP, and in the group of patients who had an intermediate to high risk of death, the 5-year survival rate was approximately 74% for those treated with high-dose therapy, compared to only approximately 44% for those treated with CHOP.
The researchers concluded that initial therapy with high-dose therapy and an autologous stem cell transplant improves long-term survival compared to CHOP for aggressive NHL. Further clinical trials are necessary to determine if these survival outcomes remain with the addition of the biologic agent Rituxan® (rituximab) to both CHOP and stem cell transplantation. Patients with aggressive NHL may wish to speak with their physician about the risks and benefits of high-dose chemotherapy and autologous stem cell transplantation as initial therapy.
Reference: Milpied N, Deconinck E, Gaillard F, et al. Initial treatment of Aggressive Lymphoma with High-Dose Chemotherapy with Autologous Stem-Cell Support. The New England Journal of Medicine. 2004;350:1287-1295.
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