Tag: NHL

Lymphoma in the News: Family History May Be a Risk Factor for Non-Hodgkin Lymphoma

By Peter Martin, MD

A recently published study from investigators at Stanford University and in Lund University in Sweden used data from a large Swedish cohort study, birth records, and cancer registries to look for risk factors associated with development of non-Hodgkin lymphoma (NHL). The investigators evaluated the records of over 3.5 million people, including 936 with NHL, born between 1973 and 2008.

They reported that family history of NHL was associated with development of NHL in early life. Specifically, history of NHL in a sibling increased the risk of developing NHL roughly nine-fold while having a parent with NHL increased the risk of NHL roughly two-fold. Importantly, the overall incidence rate of NHL was 1.4 per 100,000 person-years (the number of people x the number of years of follow-up per person). Therefore, a two-fold increase, although statistically significant, would only have increased the rate to roughly 3 per 100,000 person years. Moreover, only 4 of the 936 cases had a sibling with NHL and 10 had a parent with NHL.

These small numbers, although statistically significant, make it difficult to make any definitive conclusions regarding the degree of risk. The lack of data regarding environmental exposures, infections, and other co-existing conditions (e.g., immunodeficiencies) make it difficult to determine whether the familial association of NHL is due to an inherited condition or some other unmeasured factor. Despite the issues, the results are consistent with the concept that genetic factors may contribute to NHL. It is possible that contemporary studies using next generation sequencing of the genomes of patients and family members could yield more conclusive results. The risks and benefits of such studies, however, need to be weighed very carefully.

New Weill Cornell Study: Aurora Kinase A Inhibitor MLN8237 in Peripheral T-Cell non-Hodgkin Lymphoma

Update: this study is closed to enrollment. 
The Weill Cornell Lymphoma Program is now enrolling people in a new clinical trial for patients with peripheral T-cell lymphoma, a type of non-Hodgkin lymphoma that generally has a poor outcome with conventional chemotherapy.

The purpose of this study is to determine the effect of the experimental drug MLN8237 on patients with relapsed or refractory peripheral T-cell lymphoma. MLN8237 is an Aurora Kinase A inhibitor that has been developed to interfere with cell division, which is required for cancer to grow. It has been shown to have anti-cancer activity in laboratory studies as well as in patients who have non-Hodgkin lymphoma including peripheral T-cell lymphoma in earlier phase I/II studies.

MLN8237 is available as a tablet. Patients will take MLN8237 on Days 1-7, twice a day with 8 ounces of water. Patients will continue with this treatment every 3 weeks for up to a year as long as their disease does not get worse. Whether patients remain on study treatment or not, the study physician will follow their health status for a maximum of 2 years from study enrollment.

Key eligibility:

  • Relapsed/refractory peripheral T-cell non-Hodgkin lymphoma
  • Must have received at least one course of prior systemic therapy which may include chemotherapy, antibody therapy or immunotherapy
  • May have received prior radiation in combination with systemic therapy
  • Must not have received a previous allogeneic stem cell transplant or be within 90 days of autologous stem cell transplant
  • Detailed eligibility reviewed when you contact the study team

For more information about the study, call June Greenberg, RN at (212) 746-2651 or email June at jdg2002@med.cornell.edu.

The physician leading the study at Weill Cornell is Dr. Jia Ruan. Click here to read Dr. Ruan’s clinical and research profile.

Click here to view all current lymphoma clinical trials at Weill Cornell Medical College.

ASH Conference: Radioimmunotherapy as Part of First Line Therapy for Low Grade Lymphoma

By Rebecca Elstrom, MD

Update: this study is closed to enrollment. 

Radioimmunotherapy (RIT), or radiation targeted to lymphoma cells through conjugation to a monoclonal antibody, has long been known to be effective therapy in patients with relapsed indolent non-Hodgkin’s lymphomas.  Its use as first line therapy has been limited, however. This weekend at the American Society of Hematology (ASH) meeting, several studies exploring the use of RIT in initial therapy of low grade lymphomas, either alone or following chemotherapy, were reported.

Two studies explored the use of 90Y-ibritumomab tiuxetan (Zevalin) alone;  one presented by Dr. Pica of Genova on behalf of an Italian cooperative group exploring a single dose, and one presented by Dr. Illidge from the University of Manchester with fractionated dosing (multiple doses of the RIT, in this case 2). Both studies showed high response rates with this brief and simple strategy, and durations of remission comparable to front line chemotherapy with no excessive toxicity.

Two other studies explored the use of RIT as consolidation following initial chemotherapy. The first, presented by Dr. Press of the University of Washington, was a large multicenter study comparing Rituximab plus CHOP chemotherapy (R-CHOP) to CHOP followed by 131I-tositumomab (Bexxar). There was no difference between the two groups in response rate or duration of response. A caveat to this study is the fact that, at the time it was designed, there was concern that giving the anti-CD20 antibody rituximab prior to RIT would inhibit radiation dose delivery, as 131I-tositumomab also requires binding to CD20 in order to deliver the radiation dose to lymphoma cells. This concern does have support in laboratory studies, but it has become clear in the years since this study was designed that anti-CD20 antibody therapy with rituximab is a critical contributor to response and survival in follicular lymphoma. The second study of chemotherapy followed by RIT was presented by Dr. Fowler of MD Anderson Cancer Center. This group evaluated an induction chemotherapy regimen containing rituximab, fludarabine, mitoxantrone and dexamethasone (R-FND) followed by 90Y-ibritumomab tiuxetan. This study showed high response rates and long time to progression, but toxicity of the regimen was of some concern, possibly due to the fact that fludarabine has significant bone marrow suppressive effects, which is also the main side effect of RIT.

Overall, these presentations confirmed the impressive activity of RIT in low grade lymphoma, and extended the experience using RIT as part of first line therapy, demonstrating feasibility, safety and efficacy of this simple and very well tolerated therapeutic approach.

At Weill Cornell Medical College we are exploring radioimmunotherapy as first treatment of follicular lymphoma using a combined strategy of non-radiation tagged antibody to CD20 in combination with radio-labeled antibody against an alternative protein, CD22. This study is designed to maximize the benefit of anti-CD20 directed therapy in addition to radiation dose delivery by targeting the radio-labeled antibody to an alternative target. Click here to read more about this study.