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