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Treating Follicular Non-Hodgkin's Lymphoma

Posted Aug 24 2008 1:49pm
ALEXANDRA LEVINE, MD: Follicular lymphoma is not unusual at all in the United States. It is a disease that is associated with long survival, even though we cannot traditionally cure it today.

MORTON COLEMAN, MD: It tends to be a disease more of the elderly than of the young, but it is possible to see it in patients 30 and 40 years old.

ANNOUNCER: Twenty-two percent of all non-Hodgkin's lymphoma is classified as follicular lymphoma. It develops from malignant B-lymphocytes or B-cells and is usually of the indolent type.

MORTON COLEMAN, MD: Follicular lymphoma tends to be very indolent, very lazy. Sometimes, we don't even treat the disease. Certainly initially, we are willing to watch the patient to see what happens.

ANNOUNCER: When a patient begins to experience symptoms, such as fatigue, loss of appetite, weight loss or lymph node swelling many doctors may begin treatment.

MORTON COLEMAN, MD: We have a wide range of treatments for follicular lymphoma. Some of the treatment options are chemotherapy; immunotherapy, primarily monoclonal antibody therapy, although there are experimental use of vaccines now in patients.

ANNOUNCER: Monoclonal antibodies target proteins on the surface of lymphoma cells.

DAVID FISHER, MD: I think the most important drug is a drug called Rituxan. It's a manmade antibody that binds to a protein on the lymphocytes called CD20.

ALEXANDRA LEVINE, MD: Once that attachment occurs, the antibody attaching to the lymphoma cell, that whole complex goes to the spleen. And in the spleen, that complex is removed by a cell in the spleen and it is literally digested or destroyed.

ANNOUNCER: Rituximab can be used by itself or in combination with chemotherapy.

DAVID FISHER, MD: There are a number of studies now that show, by adding Rituxan to the chemotherapy, it can work much better.

ALEXANDRA LEVINE, MD: The side effects of rituximab are very interesting because they're different from the usual side effects of chemotherapy.

DAVID FISHER, MD: The main side effect is an allergic-type reaction. Fever, chill, or an asthmatic-type reaction or tightness in the throat.

ALEXANDRA LEVINE, MD: We will treat the patient to try to prevent those symptoms when the antibody is given for the first time. So we will use drugs to prevent fever, drugs to prevent allergy or rashes.

ANNOUNCER: These symptoms usually don't re-occur after the first treatment.

ALEXANDRA LEVINE, MD: The average survival of patients with indolent or low grade lymphoma has been stable ever since the 1960s. And now with these new antibodies and so forth for the first time in 40 years, or approaching 50 years for the first time, we are seeing a statistically improved, prolonged survival in those patients.

ANNOUNCER: Doctors may also treat patients with radioimmunotherapies like Zevalin and Bexxar to deliver radioactivity directly to the tumor cells.

MORTON COLEMAN, MD: We tag a radioisotope onto the monoclonal antibody, that's pretty much like saying if you wanna make sure you can shoot down that plane, you'll not only hit it with the missile, but you'll attach an explosive.

ALEXANDRA LEVINE, MD: Some of the recent data suggests that as many as 70 percent of patients who have not responded to the antibody alone will respond very nicely to the radioimmunotherapy.

MORTON COLEMAN, MD: If patients don't respond to these "more conventional approaches," then we can also consider the patient for transplantation and we have several options with transplantation.

DAVID FISHER, MD: One approach that's being used for quite some time now is stem cell transplant, using high doses of chemotherapy that require receiving your own stem cells back to recover your blood counts or using donor stem cells. And I think donor stem cells are very interesting, because it's giving a new immune system to the patient and that allows the immune system to go on and attack the lymphoma for years and can be very effective.

ANNOUNCER: Researchers are continuing to study new therapies for the treatment of follicular lymphoma.

ALEXANDRA LEVINE, MD: Just because it cannot be cured today does not mean that it won't be cured tomorrow, and with all of the exciting advances being made right now, this is a very important time for patients with follicular lymphoma.

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