Amrita Krishnan, M.D., and City of Hope colleagues have devised a new hematopoietic cell transplant procedure for older patients that includes a more intense conditioning regimen — but without increased toxicity.
Non-Hodgkin’s lymphoma patients ages 60 and above have traditionally been excluded from stem cell transplants because of the side effects, especially those from total body irradiation. Yet these patients often have aggressive lymphomas that may respond to such treatment.
“The issue was that older patients with lymphoma do badly — so can we transplant them with something that will increase the efficacy of the treatment?” said Krishnan, associate director of the Department of Hematology & Hematopoietic Cell Transplantation.
“There has been a lot of literature about older patients, examining why they do less well in cancer therapies,” Krishnan explained. “Is it because we’re afraid to give it to them? Can’t they tolerate it? Is their disease more aggressive? This study showed that you can transplant older patients if they have good functional status, and that physiologic age superseded chronologic age.”
The phase II trial was conducted on 41 patients from 2002 to 2006. While the typical patient was 60 years old, the oldest patient was 78 (and is now 81). The trial included patients previously considered ineligible for total-body irradiation because of their age or prior radiotherapy.
Researchers evaluated a combination of the radioimmunotherapy drug Zevalin along with high-dose carmustine, cytarabine, etoposide and melphalan (called BEAM by physicians) and autologous stem cell transplantation in patients with non-Hodgkin’s lymphoma. The team included Andrew Raubitschek, M.D., chair of the Department of Cancer Immunotherapeutics & Tumor Immunology, and Auayporn Nademanee, M.D., professor in the Department of Hematology & Hematopoetic Cell Transplantation.
Researchers found that patients tolerated the addition of Zevalin to the treatment and had side effects comparable to those experienced by patients on BEAM alone. “The rates of progression-free survival seen in these patients are promising and warrant additional study,” Krishnan said.
The study, published earlier this year in the Journal of Clinical Oncology, is especially encouraging for patients with diffuse large cell lymphomas, she added.
Researchers will next look at the regimen’s effectiveness against certain types of lymphoma to see if it is more successful than the traditional approach.
“This has become a regimen people are very interested in worldwide,” Krishnan said.
About non-Hodgkin’s lymphoma
Non-Hodgkin’s lymphomas are cancers of the immune system. Although most cases happen
in those age 60 or older, these cancers can occur at any age. Symptoms include enlarged lymph nodes, fever and weight loss.
More than 62,100 people in the United States will be diagnosed with non-Hodgkin’s
lymphoma and more than 19,100 will die of the disease this year, according to the American
Cancer Society.
