Lymphoma

Randomized trials are defining the role of autologous stem-cell transplantation in aggressive non-Hodgkin’s lymphoma (NHL), but there is less experience with this treatment in follicular lymphomas. Approximately 40% to 50% of patients with follicular NHL are in remission 4 to 5 years following autologous stem-cell transplantation. Results from phase II studies and retrospective analyses are remarkably similar, despite differences in patient populations, preparative regimens, use of purging, and source of stem cells. Nevertheless, there is little evidence of a plateau in disease-free survival curves, and we do not know whether patients are cured or overall survival is prolonged. Relapses 9 years following transplantation have been described.[1]

Most patients with advanced-stage follicular non-Hodgkin’s lymphoma (NHL) are not cured with conventional therapy. The use of high-dose therapy and autologous stem-cell transplantation in patients with relapsed follicular

We previously reported that “in vivo purging” with rituximab (Rituxan) during stem-cell collection is safe and does not adversely affect engraftment. We now report on our transplant experience with rituximab. From June 1998 to December

PORTLAND, Oregon-A rationally designed drug now known as STI 571 is both effective and well tolerated in treating certain leukemia patients that have not responded to other therapies. The results of two phase I clinical trials using STI 571 for chronic myelogenous leukemia (CML) and acute lymphoblastic leukemia (ALL) were reported by Brian Druker, MD, of the Oregon Health Sciences University in Portland, at the ASH meeting. The trials were conducted in collaboration with M.D. Anderson Cancer Center in Houston, Novartis Pharmaceuticals in East Hanover, New Jersey, and the University of California at Los Angeles.

NEW YORK-Acute myelogenous leukemia (AML) is an aggressive disease. But improved diagnosis with cytogenetic examinations and other special studies have made it possible to select the most effective induction therapy, Frederick R. Appelbaum, MD, told patients at a teleconference sponsored by Cancer Care Inc. and the Leukemia Society of America.

NEW ORLEANS-The monoclonal antibody tositumomab (Bexxar) showed promising efficacy in low-grade and follicular non-Hodgkin’s lymphoma in several preliminary studies reported during poster presentations at the ASH meeting.

NEW ORLEANS-2-Chlorodeoxyadenosine (cladribine, 2-CdA [Leustatin]) can produce response rates of 80% and higher in patients with mantle cell lymphoma (MCL), according to two studies presented at the ASH meeting. One study examined 2-CdA as monotherapy, and the other studied it combined with mitoxantrone (Novantrone).

BOSTON-Adding rituximab (Rituxan) to cyclophosphamide, doxorubicin, vincristine, prednisone (CHOP) induction therapy may provide a cleaner source of autologous stem cells for use following high-dose therapy in mantle cell lymphoma, Orion Howard, MD, reported at the ASH meeting.

NEW ORLEANS-STI 571, an investigational drug for the treatment of chronic myelogenous leukemia (CML), produced complete hematologic responses in all patients receiving higher doses, according to preliminary analysis of phase I data presented at the 41st Annual Meeting of the American Society of Hematology (ASH) (see illustration ). All participants had failed interferon-alfa therapy.

High-dose therapy with hematopoietic progenitor-cell transplantation plays a key role in the treatment of Hodgkin’s disease and the non-Hodgkin’s lymphomas. First and foremost, transplantation is used as a salvage treatment for those who relapse or do not achieve a complete remission with first-line chemotherapy. Carefully selected patients with poor prognostic features may benefit from the incorporation of high-dose therapy and transplant into their initial treatment programs. Despite a myriad of trials, many pivotal questions regarding the appropriate application of high-dose therapy with transplantation to the lymphoid malignancies remain unsettled, including the role of allogeneic transplantation and the optimal timing of transplant for patients with poor prognostic indicators. Phase III studies are required to address these issues; these trials will demand the active commitment of concerned transplanters and referring hematologists and oncologists. Although autologous transplantation has been the preferred approach for the majority of patient subgroups, new approaches to allogeneic transplantation that have diminished toxicity may pave the way for a greater role for allogeneic grafting in the lymphoid diseases. [ONCOLOGY 13(12):1635-1645, 1999]

LUGANO, Switzerland-Dose-escalated BEACOPP chemotherapy (bleomycin, etoposide, Adriamycin [doxorubicin], cyclophosphamide, Oncovin [vincristine], procarbazine, and prednisone) with growth factor support boosts survival in patients with advanced Hodgkin’s disease, according to the fourth interim analysis of the German Hodgkin’s Lymphoma Study Group’s (GHSG) HD9 trial.

Data published in a recent issue of Blood suggest that valspodar (Amdray), a multidrug resistance modulator being developed by Novartis Pharmaceuticals Corporation, may show promise in treating certain patients with acute myelogenous leukemia

The combination of fludarabine and mitoxantrone (FM) has been shown to be an effective regimen for indolent lymphoma (J

The polymerase chain reaction (PCR) assay provides a powerful means of detecting minimal residual disease in follicular

About 20%-50% of patients with stage IV Hodgkin’s disease may suffer a relapse after initial chemotherapy-induced remission. Consolidative radiotherapy has been used in combination with chemotherapy to reduce relapse at areas of initial bulky disease; however, no survival benefit has been shown in the few randomized studies.

Rituximab (Rituxan), a chimeric monoclonal antibody (MoAb), binds with high affinity to the CD20 antigen found on malignant and normal B-cells, but not on other normal tissues. CD20 is an attractive target because of the accessibility and sensitivity of malignant B-cells to lysis via immune effector mechanisms. This MoAb mediates complement-dependent cell lysis and antibody-dependent cellular cytotoxicity. Also, it has been shown to sensitize chemoresistant human lymphoma cell lines and to induce apoptosis in vitro.

From July 1994 until March 1998, 131 patients with follicular lymphoma, all grades, were randomized between 12 courses of

Patients with advanced Hodgkin’s disease-Ann Arbor stage IIB to IV-were randomized to treatment with either four

We have previously shown that disease status at the time of autologous bone marrow transplant (BMT) and relapse in a prior radiation field are the most important predictors of outcome for patients with relapsed or primary refractory Hodgkin’s disease (J Clin Oncol 11:704,1993). We have extended this analysis to include 194 patients treated at our center, with a median follow-up of 5 years (range, 1 month to 10 years). All patients were treated with salvage chemotherapy (usually DHAP [dexamethasone, ara-C, and Platinol] or mini-BEAM [BCNU, etoposide, ara-C, and melphalan]) to maximum response, and received the same high-dose chemotherapy regimen, consisting of etoposide (60 mg/kg) and melphalan (160 mg/m²).

MIAMI BEACH-Long-term follow-up of 23 patients with Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia (ALL) in first complete remission showed a relatively low relapse rate at 3 years when treated with allogeneic bone marrow transplant from HLA-matched siblings, D.S. Snyder, MD, reported at the American Society of Hematology (ASH) annual meeting.

The role of radiotherapy in combination with chemotherapy in advanced-stage Hodgkin’s disease remains controversial.

This report aims to assess the effect of increased drug dose on the efficacy and toxicity of the BEACOPP regimen with

The chimeric monoclonal anti-CD20 antibody rituximab (Rituxan) has been shown to have clinical activity in patients with

MIAMI BEACH-Chronic inflammation due to Helicobacter pylori infection is the “underlying disease” that causes some gastric lymphomas, and curing the infection produces durable remissions of the neoplasms, Andreas Neubauer, MD, said at the American Society of Hematology (ASH) annual meeting.

LYON, France-The addition of interferon-alfa-2b (IFN, Intron A) to the usual CHVP regimen (cyclophosphamide, doxorubicin, teniposide, prednisone) extends survival in elderly patients with high-risk follicular lymphoma, Dr. Bertrand Coiffier said at the ASH meeting.