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Monoclonal Antibodies in Aggressive NHL

Posted Aug 24 2008 1:49pm
JOHN LEONARD, MD: The aggressive forms of non-Hodgkin's lymphoma can be cured, in many situations. And so, for most patients, the goal is to go through the treatment, to potentially cure the disease and hope that it doesn't come back at all.

ANNOUNCER: The most common type of aggressive non-Hodgkin's lymphoma is what's called diffuse, large B-cell lymphoma.

JOHN HAINSWORTH, MD: This has been a lymphoma that for many years has had potentially curative treatments. Not in everybody, but in a fair percentage, say about 40 percent.

ANNOUNCER: Doctors are always looking for ways to improve initial treatment. And in the late 1990s, they began studies using a new type of drug, called a monoclonal antibody, in combination with standard chemotherapy. The drug was rituximab, and clinical trials with older patients with a subtype of NHL called diffuse, large B-cell lymphoma showed good results.

SANDRA J. HORNING, MD: Well the changes in terms of statistical significance with the addition of rituximab to chemotherapy were extremely high. Overall we are talking about improvements in outcomes that are in the range of 10 to 20 percent, depending on the study and the subpopulation of patients.

ANNOUNCER: Then came studies with younger patients. The same results emerged.

SANDRA J. HORNING, MD: Well, subsequent to the studies in older patients, there have been studies done in younger patients as well, and all of these are very concordant in showing the definite advantage of combination therapy. And in fact, in younger patients with less advanced disease, the results are even more stunning, if you will, in favor of higher cure rates and improved survivals.

ANNOUNCER: Doctors say with chemotherapy alone, younger patients with localized disease might face a 70 percent cure rate. The addition of rituximab increases that even more.

JOHN LEONARD, MD: And so the standard treatment for aggressive lymphoma of B-cell type, which is the most common type, is now to use generally CHOP plus rituximab.

ANNOUNCER: In aggressive lymphoma, if relapse does not occur within two years of initial therapy, it is very unlikely to recur at all, and doctors say a patient has been cured. Enough time has passed since the first patients received rituximab and chemotherapy to demonstrate the value of the combination.

JOHN HAINSWORTH, MD: We now have follow-up with these trials and these patients of between five to seven years, which is much longer than it takes to declare whether someone's going to relapse or not. So these patients are way past the follow-up time that they're at risk for recurrence. And yes, we can say these patients are cured, and they're not going to have any more trouble with this lymphoma.

ANNOUNCER: But what about the other patients, when the lymphoma does return?

JOHN LEONARD, MD: Typically, those patients are treated with additional chemotherapy, and if that additional chemotherapy works well, then often patients will go on to what's called high-dose chemotherapy and autologous stem cell transplant; basically, a fancy way to give higher doses of chemotherapy.

ANNOUNCER: Stem cell transplants are not always an option for a patient with recurrent, aggressive lymphoma. For those patients, chemotherapy may still be helpful. Or patients may try a variety of other drugs that are being tested in clinical trials.

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