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ASCO Update: Non-Hodgkin’s Lymphoma

ASCO Update: Non-Hodgkin’s Lymphoma

ABSTRACT: This and future reports are written by oncologists from Pacific Shores Medical Group (a large group practice in Long Beach, California). The reports are primarily based on notes taken at the American Society of Clinical Oncology annual meeting (San Francisco, May 2001). The reports include a summary of the presentations at ASCO, plus our own impressions (shown in italic type) of the clinical significance of the studies. The information is intended to help you get updated on new developments in oncology. The coverage of the meeting is not meant to be comprehensive, but rather focused on highlights that we consider most interesting or relevant. We hope these reports will be of some value to the readers of Oncology News International.

Maintenance With Rituximab Improves Response

In abstract #1175, Dr. John Hainsworth presented results on the treatment of
indolent low-grade non-Hodgkin’s lymphoma (NHL) with rituximab (Rituxan)
given as induction followed by maintenance cycles every 6 months. Sixty-two
patients were entered in this study from 1998 through 1999, and the response
rate is very favorable with minimal side effects. Interestingly, the response
rate has increased after additional maintenance courses of rituximab, and two
thirds of the patients are free of progression at 2 years for both follicular
and small lymphocytic histologies. The authors indicated that repeated courses
of rituximab at 6-month intervals improved responses in 30% of patients without
increasing the toxicity.

Early-Stage Primary Gastric Lymphoma

Abstracts #1186 and #1187, presented by Dr. P. Koch from Germany and Dr. B.
Pro from Texas, respectively, discuss results with regard to the treatment of
early-stage primary gastric lymphoma with nonsurgical therapies. Dr. Koch
presented an analysis of a database of about 370 patients and concluded that
primary chemotherapy or a combination of chemotherapy and irradiation is very
effective primary therapy and that surgery for these early lesions does not
improve outcome, but is associated with toxicity and morbidity due to the
effects of gastrectomy. Dr. Pro presented results on 45 patients treated with
chemotherapy, with or without radiotherapy for stage I and II gastric lymphoma.
Dr. Pro reported that 43 of 45 patients (95%) achieved a complete remission,
and the projected 5-year overall disease-specific survival was 90%.
Importantly, however, there were two treatment-related deaths (4%), one with
sepsis and the other with gastrointestinal bleeding, both of which were on
treatment. Dr. Pro concluded that chemotherapy with or without radiation
therapy is associated with high response rates and excellent survival in
early-stage primary gastric lymphoma, thus avoiding the complications of
surgery.

Our impression from these two trials is that primary chemotherapy with or
without irradiation is a reasonable option for early-stage primary gastric
lymphoma. One has to be very careful, however, and individualize the therapy,
particularly in trying to avoid the risk of perforation and local bleeding.
These risks are real and need to be considered in a multidisciplinary approach
with close consultation with the gastroenterologist and the surgeon.

Primary Paranasal Sinus Lymphoma

Dr. Janessa Laskin from Canada (abstract #1188) presented results on the use
of central nervous system (CNS) chemoprophylaxis with intrathecal chemotherapy
in patients with primary paranasal sinus lymphoma. This disease is an uncommon
presentation of extranodal lymphoma that is associated with a high risk of CNS
involvement. Indeed, in this series of 44 patients analyzed retrospectively
since 1980, the authors observed that the risk of CNS recurrence or involvement
declined from 40% prior to the institution of intrathecal chemotherapy in 1984
down to only 8% after 1984. In fact, intrathecal prophylaxis was also
associated with an improvement in overall survival from 20% to 50%.

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