Radiation therapy in combination with chemotherapy with methotrexate, doxorubicin, cyclophosphamide, vincristine, prednisone, and bleomycin produced good survival rates in persons with primary mediastinal large B-cell lymphoma with sclerosis, according to a recent report by Italian researchers.

Primary mediastinal large B-cell lymphoma with sclerosis is a type of non-Hodgkin’s lymphoma. Non-Hodgkin’s lymphoma (NHL) is a cancer of the lymph tissue, which is present in the lymph nodes, lymph vessels, bone marrow, and organs such as the thymus, tonsils, and spleen. One of the main cells in the lymph system is the lymphocyte, of which there are 2 types: B and T cells. The rapid multiplication of lymphocytes leads to an excess of these cells, and can crowd out other blood cells in the bone marrow. The bone marrow (and circulating blood) contains early blood-forming cells, called stem cells, which grow and mature into the 3 blood cell types: white blood cells (protect the body from infection), red blood cells (carry oxygen to the tissues), and platelets (help the blood to clot). NHL is categorized by the type of lymphocyte it involves (B cell or T cell), as well as by the specific appearance of the affected cells under a microscope (called the histologic findings). This determination can help predict how quickly the cancer is likely to grow. Indolent NHL is a slow-growing lymphoma, while aggressive NHL is, as it sounds, the faster growing disease. Primary mediastinal large B-cell lymphoma with sclerosis is an aggressive B-cell type of NHL that begins in the mediastinum, the space between the 2 lungs, and is characterized by sclerosis, a hardening of certain tissues in this area.

The treatment options for aggressive forms of NHL depend on the specific type and stage (extent of disease at diagnosis) of disease, but may include chemotherapy, radiation therapy, or a combination of chemotherapy and radiation therapy. Researchers continue to develop and study new drugs and drug combinations in an effort to provide persons with this disease with more effective treatment options.

Researchers in Italy treated 50 persons who had mediastinal large B-cell lymphoma with sclerosis. All patients received chemotherapy with methotrexate, doxorubicin, cyclophosphamide, vincristine, prednisone, and bleomycin (MACOP-B), as well as radiation therapy to the mediastinal area. During chemotherapy, 3 patients experienced a progression of their disease. However, after radiation therapy, 43 patients (86%) had a complete response to the treatment. After 96 months, 93% of these individuals are alive and free of disease. The overall survival rate for the group is more than 80%. In addition, the researchers found that the use of a test called a gallium scan was more effective than the commonly used computerized tomography (CT) scan for detecting small amounts of cancer that were still present after the treatment. Detecting this residual disease early is important in making further treatment decisions with each patient.

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These researchers concluded that the MACOP-B chemotherapy/radiation therapy regimen is effective against mediastinal large B-cell lymphoma with sclerosis. Persons who have this type of disease may wish to talk with their doctor about the risks and benefits of participating in a clinical trial (research study) in which the MACOP-B/radiation therapy regimen, or another promising new treatment strategy is being studied. Two sources of information on ongoing clinical trials include 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. (Blood, Vol 94, No 10, pp 3289-3293, 1999)

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