Tag: research publications

ASCO 2013: Post-therapy Surveillance Imaging has Limited Use in Detection of Relapse of Non-Hodgkin Lymphoma

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By Peter Martin, MD

Despite the frequent use of routine post-therapy imaging as a means of early detection of lymphoma relapse, there is limited evidence that regular scanning improves patient outcomes. Two groups reported on their experience with surveillance imaging at the recent annual meeting of the American Society of Clinical Oncology in Chicago.

Dr. Quoc Van Truong of the West Virginia School of Medicine retrospectively evaluated 77 patients with non-Hodgkin lymphoma that had relapsed after achieving a complete response with initial treatment. Despite the frequent use of routine imaging, nearly 80% of relapses were detected by patient-reported symptoms and not surveillance imaging. Overall, there was no survival difference between the groups of patients whose relapse had been detected by scans versus those reporting additional symptoms. Additionally, surveillance imaging led to 2 false positive scans resulting in unnecessary invasive procedures.

Dr. Carrie A. Thomas of the Mayo Clinic reported on an analysis of 644 patients with DLBCL seen at the Mayo Clinic or University of Iowa between 2002 and 2009. A total of 537 patients entered post-treatment observation, and 109 of these patients relapsed while 41 died from other causes. At the time of relapse, 68% were symptomatic, 42% had an abnormal physical exam, 55% elevated LDH, and 87% had more than one of these features. Of the 38 patients whose relapse was detected during a planned visit, 26 displayed clinical features of relapse, while the relapse of the other 12 patients was detected by planned surveillance scan. Of these 12 relapses exclusively detected by the planned surveillance scan; 4 presented a low-grade or other subtype and 8 had DLBCL (4 of whom had equivocal/positive scans at the end of treatment). The authors concluded that post-therapy surveillance scans have little value in detecting DLBCL relapse.

These studies add to the growing body of literature suggesting that lymphoma patients that achieve a complete remission from first-line therapy may not benefit from routine imaging. We recommend that patients discuss plans for post-treatment surveillance with their physician.

Lymphoma Vaccine Increases Disease-Free Survival in Clinical Trial

By Peter Martin, MD

Researchers at The University of Texas MD Anderson Cancer Center report that a follicular lymphoma vaccine uniquely tailored for each patient extended disease-free survival by 14 months. The results were recently published online in the Journal of Clinical Oncology. Click here to read the published abstract.

To make the vaccine, unique proteins from each patient’s tumor were isolated and combined with a delivery agent and a growth factor. This mixture was then injected back into the patient.

Earlier studies have shown that lymphoma vaccines are able to induce anti-tumor immune responses in some patients. Importantly, patients that produced an immune response seemed to have longer remissions than those that did not. However, when the vaccines were tested in phase 3 studies, the results were not as impressive. Two phase 3 studies comparing vaccines vs no vaccine in patients with follicular lymphoma have been reported. The MD Anderson study is the first phase 3 study to demonstrate a benefit for patients receiving vaccine.

Notably, there were a few important differences between the most recent study and the two prior studies. Continue reading “Lymphoma Vaccine Increases Disease-Free Survival in Clinical Trial”

Lymphoma in the News: No Benefit to Rituximab Maintenance Following Autologous Stem Cell Transplantation in Patients with Relapsed DLBCL

By Peter Martin, MD

Patients with diffuse large B-cell lymphoma (DLBCL) that has relapsed following first-line chemotherapy are typically offered second-line chemotherapy followed by autologous stem cell transplantation (bone marrow transplantation using the patient’s own stem cells).

The CORAL study, a recently completed international phase 3 trial, evaluated whether rituximab following the transplant procedure could improve patient outcomes. The results of the study were recently presented at the American Society of Clinical Oncology (ASCO) annual meeting.

Following second-line chemotherapy (R-ICE or R-DHAP) and stem cell transplant, 242 patients were randomized to receive rituximab given every two months for one year or observation. By four years, there was no difference in rate of progression or survival between the two groups. Interestingly, women that received rituximab maintenance did considerably better than men that received rituximab maintenance while there was no difference in outcomes between the two genders in the observation group.

Based on these results, there does not appear to be an advantage to rituximab maintenance following stem cell transplantation for DLBCL.

Click here to read the abstract of the CORAL study results as presented at the ASCO annual meeting.