According to a recent article published in the journal Cancer, intrathecal chemotherapy may prevent recurrent cancer in aggressive non-Hodgkin’s lymphoma.
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, blood 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 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 involves cancer of the B-lymphocytes and characterized by the excessive accumulation of these atypical cells. This results in overcrowding of blood and lymph tissue, suppressing the formation and function of blood and immune cells that are normally present. Additionally, the cancerous lymphocytes themselves do not function normally, leading to a further decrease in the ability of the body to fight infection. Aggressive NHL means that the cancer cells are growing and spreading rapidly.
Although many patients may have a disappearance of cancer (remission) following therapy, some may have a cancer recurrence in their central nervous system (CNS), which nearly always leads to death. CNS cancers are often treated with intrathecal chemotherapy, which is chemotherapy that is placed through a membrane surrounding the spine and into the spinal fluid. The spinal fluid bathes the spinal column and brain and the membrane surrounding the fluid is often impermeable to agents that reach the rest of the body, so physicians often have to deliver a chemotherapy agent directly into the spinal fluid.
Researchers from Japan recently analyzed data from 68 patients with aggressive NHL who were treated with standard chemotherapy and achieved a complete remission. One group of patients (29) received preventive intrathecal chemotherapy (methotrexate) and hydrocortisone, a steroid, and the other group of patients (39) did not receive any preventive CNS treatment. At an average of 40 months following therapy, not one of the patients who received intrathecal chemotherapy experienced a CNS recurrence, compared to 15% of patients who did not receive preventive CNS therapy. Five years following therapy, overall survival was 80% in patients treated with intrathecal therapy, compared to 58% in patients who did not receive intrathecal therapy. Cancer-free survival at five years following therapy was 85% for patients treated with intrathecal therapy, compared to only 50% for patients not treated with the additional therapy.
These researchers concluded that although future trials need to be conducted in order to confirm these findings, it appears that intrathecal preventive therapy may reduce the risk for CNS recurrences and improve survival in patients with aggressive NHL who achieve a complete disappearance of cancer following standard chemotherapy. Patients with aggressive NHL may wish to speak with their physician regarding the risks and benefits of participating in a clinical trial further evaluating preventive intrathecal chemotherapy or other promising therapies. 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: Tomita N, Kodama F, Kanamori H, et al. Prophylactic intrathecal methotrexate and hydrocortisone reduces central nervous system recurrence and improves survival in aggressive non-hodgkin lymphoma.