According to results recently presented at the 43rd annual meeting of the American Society of Hematology, patients with advanced follicular non-Hodgkin’s lymphoma who are initially treated with high-dose chemotherapy and autologous stem cell transplant experience significantly fewer cancer recurrences than patients treated with standard chemotherapy and interferon.
Non-Hodgkin’s lymphoma (NHL) is a cancer of the lymph tissue, which is part of the body’s immune system. Lymph tissue is present in lymph nodes, lymph vessels and bone marrow, which exist throughout the body. It is also present in organs such as the thymus, tonsils and spleen. The main cells in the lymph system are called lymphocytes, of which there are two types: B and T-cells. Each of these cells has a very specific function in aiding the body to fight infection. The large majority of NHL cases, including follicular NHL, involve cancer of the B-lymphocytes and are characterized by excessive accumulation of these atypical cells. This causes overcrowding of blood and lymph tissue, suppressing the formation and function of blood and immune cells that are normally present. Additionally, the cancerous lymphocytes themselves do not function normally, leading to a further decrease in the body’s ability to fight infection. Follicular lymphoma is a slow-growing NHL whose cells appear clustered when viewed under the microscope. Most follicular lymphoma patients will have advanced disease at diagnosis, the cancer already invading many lymph nodes and possibly other body organs.
One standard initial treatment for follicular NHL is moderate-dose chemotherapy combined with interferon. The chemotherapy kills rapidly dividing cells, such as cancer cells, and interferon slows their rate of growth and division, causing them to become sluggish and die. Although chemotherapy is effective at killing cancer cells, treatment does not differentiate between cancer cells and healthy cells. High-dose chemotherapy (HDC) kills more cancer cells than lower dose conventional chemotherapy. Unfortunately, HDC also kills more normal cells, especially the blood-producing stem cells in the bone marrow. When these cells reach critically low levels, complications such as anemia, infection and bleeding can occur. The treatment strategy utilizing stem cell transplantation (SCT) is an attempt to restore the blood-producing stem cells after HDC has reduced them to dangerously low levels. During an autologous SCT, the patient’s own stem cells are collected from circulating blood before chemotherapy treatment, frozen, and infused back into the patient after treatment to “rescue” the bone marrow. HDC followed by autologous SCT is one standard treatment for patients with recurrent NHL, but not for patients with newly diagnosed follicular NHL, even in advanced stages.
Since 1994, researchers in France have conducted a clinical trial involving 150 patients comparing the efficacy of standard chemotherapy and interferon against HDC and autologous SCT as initial treatment for advanced follicular NHL. Four years following therapy, only 27% of patients treated with HDC and autologous SCT experienced a cancer recurrence, compared to 61% of patients treated with chemotherapy and interferon. While overall survival was only slightly higher for HDC and autologous SCT after four years (83% versus 80%), continued follow-up will reveal whether long-term survival benefits are incurred.
Results of this French clinical trial suggest that HDC and autologous SCT as initial treatment for advanced follicular NHL produces significantly fewer cancer recurrences than standard chemotherapy combined with interferon. Patients with advanced NHL may wish to speak with their physician about the risks and benefits of HDC and autologous SCT treatment or about participating in a clinical trial. Two sources of information regarding ongoing clinical trials include comprehensive, easy-to-use listing services provided by the National Cancer Institute (
Proceedings from the 43rd annual meeting of the American Society of Hematology, abstract 3573, Orlando, Florida, December 11-14, 2001)