In the December issue of ASH Clinical NewsLymphoma Program, Dr. John Leonard outlined an approach to treating follicular lymphoma with Dr. Jonathan W. Friedberg and Dr. Brad Kahl. Noting how improved diagnostic accuracy and novel therapeutic approaches for follicular lymphoma patients have led to overall survival rates that are now measured in decades instead of months or years, they call for a new paradigm in the clinical research that leads to the development of new therapies for follicular lymphoma.
Given these recent observations, it is clear that the vast majority of patients with FL have very prolonged overall survival and, given the asymptomatic and non-morbid nature of their disease, are at risk for over treatment. However, certain subsets of patients remain resistant to standard therapies and suffer significant morbidity and mortality from this disease.
We feel that the most important advances in FL moving forward will come from understanding the underlying “high-risk” FL biology – including the events leading to histologic transformation, a frequent cause of morbidity and mortality – and applying precision medicine approaches to this biologically defined subset. Large phase III trials enrolling unselected patients with advanced-stage FL that incorporate prolonged maintenance approaches or continuous treatment with expensive medications and that use PFS should be avoided. Even in the relapsed setting, maintenance therapy has been shown to improve PFS over observation after bendamustine treatment, as seen in the recently reported GADOLIN trial, but this observations is unlikely to translate ultimately to clinical benefit for an unselected group of patients.23
For the majority of patients with FL who will die with rather than from their disease – and who have survival length similar to their counterparts without lymphoma – it is appropriate to consider rethinking our therapeutic goals. Such patients may receive numerous treatments over many years, all of which may be associated with acute, chronic, or long-term toxicities. If the patient’s overall survival is not limited by the disease, then the objective of therapy should be to optimize his or her quality of life.
The Meyer Cancer Center recently profiled Dr. Lisa Roth and the far-reaching impact of her work in finding new targeted therapies to treat young patients with Burkitt lymphoma. Burkitt’s is an aggressive form of non-Hodgkin lymphoma that is often fatal. Finding alternative therapy options is important because,
“As many as 85 percent of children with Burkitt lymphoma respond well to treatment. Their tumors grow incredibly fast – doubling in size in a matter of days – but also shrink incredibly fast when blasted with high-dose chemotherapy. In order to ensure the tumors don’t return, they undergo intensive sustained treatment that generally lasts from 4-8 months.”
“For those who don’t respond, however, or for those whose disease returns despite the treatment, the survival rate is below 20 percent. And success is often tempered by immediate and long-term side effects, including cardiovascular problems, infertility and secondary malignancies.”
“We do very well, curing the majority of patients; the problem is the amount of chemotherapy needed to get to that cure rate is substantial,” Roth said. “As our patients are surviving longer and longer, we are beginning to see the toll the treatments are taking long-term.”
To this end Dr. Roth has received funding from the St. Baldrick’s Foundation to investigate PU-H71 a promising new therapy which kills Burkitt lymphoma cells by attacking a protein required for suvival.
Besides her work in finding new options to treat Burkitt lymphoma, Dr. Roth is building an adolescent and young adult lymphoma program at Weill Cornell Medicine. The program will focus on the needs of patients who don’t squarely fit into either the pediatric or adult categories for treatment. It will also specifically address the needs of young adult patients like fertility.
Look to this space for more information about the adolescent and young adult lymphoma program at Weill Cornell Medicine.
If you are interested in making an appointment with Dr. Roth and the adolescent and young adults lymphoma program you can call her at 646-962-2068
Mantle cell lymphoma is a B-cell non-Hodgkin lymphoma that primarily affects the elderly. Approach to initial treatment is highly variable, and decisions are made with consideration of balancing efficacy and toxicity. In this video Dr. Jia Ruan discusses results from a study published in the November 5th issue of the New England Journal of Medicine. The study demonstrated that lenalidomide when taken in combination with rituximab provides an effective treatment option .
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