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‘Excellent’ Outcomes Reported in NIH Trial of Lymphoma Therapy in Young People
Patients with primary mediastinal B-cell lymphoma (PMBCL) who received infusions of chemotherapy, but who did not have radiation therapy to the mediastinum, had excellent outcomes, according to clinical trial results. Until now, most standard treatment approaches for patients with this type of lymphoma have included radiation therapy to the mediastinum. However, mediastinal radiation is associated with substantial long-term toxic side effects.
The phase II single-arm trial, which followed 51 patients for up to 14 years, was conducted by researchers at the National Cancer Institute (NCI), part of the National Institutes of Health (NIH). The results were published in the New England Journal of Medicine.
PMBCL mainly affects people from their teenage years to their early 30s. Many patients are cured with a combination of chemotherapy and radiation therapy. However, even with this treatment, about 20% of patients experience disease progression.
Most patients receive radiation to the chest area, which can cause new cancers as well as damage to the heart. This is particularly a problem for young people because the risk of new cancers and heart disease continues to increase as they get older. PMBCL is also more common in women, who are at greater risk of developing breast cancer from radiation therapy to the chest.
In the new study, 51 patients with untreated PMBCL received etoposide, doxorubicin, cyclophosphamide, vincristine, prednisone, and rituximab in a regimen known as dose-adjusted EPOCH-R (DA-EPOCH-R). This regimen uses infusion strategies in which the doses of etoposide, doxorubicin, and cyclophosphamide are adjusted for greatest efficacy.
All but two patients achieved complete remission (CR) with DA-EPOCH-R therapy, and none of the patients with CR developed recurrent lymphoma. The two patients who did not achieve CR received radiation, and also did not have their tumors recur. There was no evidence of other diseases developing later on or of cardiac toxic effects.
Studies have suggested that PMBCL has a better outcome with more dose-intense regimens. Other studies have also demonstrated that the use of rituximab in the drug regimen may improve treatment, hence the use of DA-EPOCH-R in the new trial.
An international phase II study of DA-EPOCH-R in pediatric patients with PMBCL is ongoing to confirm the new findings.
Source: NIH; April 10, 2013.