The British Journal of Haematology recently published data suggesting that the substitution of oxaliplatin for Platinol® in a chemotherapy combination also containing dexamethasone and cytarabine is well tolerated and produces significant anti-cancer activity in patients with recurrent intermediate or high-grade non-Hodgkin’s lymphoma (NHL).
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 involve cancer of the B-lymphocytes and are characterized by excessive accumulation of these atypical cells. This causes 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, further decreasing the body’s ability to fight infection. While NHL is categorized by the type of lymphocyte it involves, it is also further defined by the specific appearance of the affected cells as well the grade of the disease (how fast it is likely to grow). These determinations are based on how the cells look under a microscope. Intermediate grade NHLs are the most common of all lymphomas and are considered aggressive in nature; high-grade NHLs are less common, but even more aggressive (faster growing).
One chemotherapy combination used to treat recurrent intermediate or high-grade NHL consists of dexamethasone, cytarabine, and Platinol® (DHAP). However, Platinol® is very hard on the body, producing severe side effects that often require reduction in dosage or termination of treatment altogether. Oxaliplatin is another chemotherapy agent that usually produces less severe side effects. When oxaliplatin is combined with dexamethasone and cytarabine, the treatment regimen is referred to as DHAX.
Researchers conducted a clinical trial to evaluate the safety and efficacy of the novel chemotherapy combination DHAX in treating recurrent intermediate to high-grade NHL. Twenty-four patients were given thrice-weekly intervals of DHAX. The average patient age was 58. Overall, 50% of the patients had an anti-cancer response to treatment. Four patients achieved complete disappearance of cancer (remission), while eight achieved partial remission. Patients undergoing treatment for a first relapse of cancer experienced significantly greater responses to treatment than did patients at the second or third relapse (77% versus 29%). The average length of survival was 10.6 months after treatment. The probability of surviving for one year post treatment was 50%, while the probability of surviving one year without cancer progressing was 47%. Patients experienced moderate to severe side effects of anemia (decrease in the number of red blood cells), neutropenia (abnormally low number of specific white blood cells) and thrombocytopenia (decrease in blood platelets).
Results from this study suggest that DHAX is safe and effective in treating recurrent intermediate and high-grade NHLs. Individuals with recurrent NHL may wish to speak with their physician about the risks and benefits of DHAX or about participating in a clinical trial. Two sources of information regarding ongoing clinical trials include comprehensive, easy-to-use listing services provided by the National Cancer Institute (cancer.gov) and eCancerTrials.com. eCancerTrials.com also provides personalized clinical trial searches on behalf of patients. (British Journal of Haematology, Vol 115, No 4, pp 786-792, 2001)
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