01 November 2013

Stem cell transplant not always effective

Early stem cell transplants do not improve overall survival in high-risk patients with aggressive non-Hodgkin's lymphoma.


Early stem cell transplants do not improve overall survival in high-risk patients with aggressive non-Hodgkin's lymphoma, but may be beneficial for a small group of patients with the very highest risk, according to a new study.

Non-Hodgkin's lymphoma is cancer of the white blood cells (lymphocytes). Larger-than-normal lymph nodes and fever are common symptoms.

Many patients with this type of cancer relapse after undergoing chemotherapy and require an autologous stem cell transplant. In that procedure, the patient's own stem cells are removed before they receive high-dose chemotherapy and/or radiation. After the chemotherapy, the patient's stem cells are returned to help replenish the body's supply of blood cells.

This study of 397 patients in the United States and Canada looked at whether giving patients a stem cell transplant before they relapsed would improve their chances of survival. The patients, who had an intermediate-high or high risk of relapse, were randomly assigned to receive an early stem cell transplant or to a "control group" that received three additional cycles of a five-drug chemotherapy regimen.

No disease progression

After two years, 69% of those in the early transplant group had no disease progression, compared with 55% of those in the control group. However, both groups had similar survival rates: 74% in the early transplant group and 71% in the control group, the study found.

This is probably because patients in the control group who relapsed were later offered stem cell transplants, according to Dr Patrick Stiff, director of Loyola University Medical Centre's Cardinal Bernardin Cancer Centre, and colleagues.

Stem cell transplantation did not improve overall survival among the entire group of high-risk and high-intermediate risk patients, the study authors noted in a Loyola news release. However, it did appear to benefit a subgroup of high-risk patients. Among these patients, the two-year survival rate was 82% in the transplantation group and 64% in the control group, according to the report published in the New England Journal of Medicine.

"Early transplantation and late transplantation appear to be roughly equivalent approaches in the treatment of the combined risk groups," the researchers concluded. However, "early transplantation appears to be beneficial for the small group of patients presenting with high-risk disease," the authors added.

It's hoped that the findings "will trigger discussions between such patients and their physicians as to the feasibility of doing early transplants," Stiff said in the news release.

More information

The US National Cancer Institute has more about non-Hodgkin's lymphoma.

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