MD Anderson OncoLog, Volume 43, Number 8, August 1998 Page: 4
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Non-Hodgkin's Lymphoma
(Continued ioin page 3)
phoma, which puts it in a category
of very active drugs with very good
duration, very minimal toxicity, and
no overlapping toxicity with chemo-
therapy." Dr. Cabanillas said the
median response time with Rituxan
was one year.
In seeking a better molecular
response in the treatment of advanced
indolent lymphomas, Cabanillas said
that researchers are seeking to elimi-
nate every possible sign of minimal
residual disease, which means looking
in both blood and bone marrow for
response.
"We have two areas that we look
at because, in some areas, patients
might attain a molecular response
in the blood but not ir the bone
marrow, or vice versa. It's a compli-
cated thing. You look art blood only,
for example, it's still better than
looking at the clinical response. But
it's probably going to be even better
if you can get a molecular response
both in the blood and the marrow,"
Dr. Cabanillas said.
Like advanced indolent lympho-
mas, early stage follicular lymphomas
often do not have a positive molecu-lar response to
standard
chemotherapy.
Early stage
follicular
lymphomas
account for
20%-25% of
all NHL, so
this lack of
response is
particularly
troublesome.
To meet the
challenge in
this area, Dr.
Cabanillas and
James Cox,
M.D., professor
of radiation
oncology and
head of the
Division"It is a major
step forward"
- Issa Khouri, M.D.,
Professor of Medicine,
Department of
Lymphoma/Myeloma,
speaking of the
improved results in
mantle cell lymphoma
treatment.of Radiation Oncology, are making
inroads by comparing very extensive
radiation therapy with the high-dose
ATT chemotherapy regimen.
A complex regimen, ATT com-
bines the following: CHOP-bleo
(cyclophosphamide, doxorubicin,
vincristine, and prednisone-
bleomycin) alternating with ESHAP
(etoposide, Solu-medrol [methyl-prednisolone, ara-C [cvtarabine],
and platinum) and NOPP (Novantrone,
Oncovin, procarbazine, and pred-
nisone). Both ATT and the extensive
irradiation, which is called central
lymphatic irradiation, Dr. Cox said,
have accomplished what standard
chemotherapy and radiation therapy
could not.
"We're very impressed that they're
both so effective," Cox said. "Both
of these approaches are more effec-
tive than more modest treatment
approaches."
Although the radiation treatment
used is extensive, it falls short of
total-body irradiation (TBI), a fact
that Cox finds encouraging, given
the positive molecular responses he
has seen. Avoiding TBI is important
in order to preserve more intensive
therapy for subsequent treatment if
it is necessary.
"The long-term results of central
lymphatic irradiation," he said, "have
been encouraging." "
FOR MORE INFORMATION, contact Dr
Cabanillas at (713) 792-2860, Di:
Khouri at (713) 794-5743, or Dr Cox
at (713) 792-3411, or call the M. D.
Anderson Information Line at (800)
392-1611 or (713) 792-6161.PROTOCOLS
(Continued from page 3')
" Randomized comparison of alternating
triple therapy (ATT) versus CHOP in
patients with intermediate grade
lymphomas and immunoblastic lympho-
mas with international ndex 2-5
(DM94-017). Physician: Fernando
Cabanilias, M.D.
Previously untreated patients who
have diffuse large cell, follicular large
noncleaved-cell, diffuse mixed, or
immunoblastic lymphoma (both T cell
and B cell) are eligible for this study.
They must be 16 years or older, have
an international index of 2-5, and have
no history of chronic obstructive or
restrictive lung disease or antecedent
malignancy with poor prognosis (<90%
probability of five-year survival). They
may have brain involvement but no
primary brain lymphoria.* Systemic vs. local therapy for stage I-Ill
low-grade lymphomas monitored by
polymerase chain reaction technique
(DM92-102). Physician: Fernando
Cabanillas, M.D.
This protocol, described in the
columns above, is for previously
untreated patients with follicular low-
grade lymphoma or small cell lympho-
cytic lymphoma, irrespective of bcl-2
status. Disease must be clinical stage I-
Ill. Patients must be <76 years old, with
no divergent histology (e.g., intermedi-
ate grade in one site and low grade in
another), no history of chronic obstruc-
tive or restrictive lung disease, and no
antecedent malignancy with poor
prognosis.
* A randomized phase Ill study of melato-
nin plus CHOP for patients with large celllymphoma, tumor score <3 (DM98-009).
Physician: Maria Alma Rodriguez, M.D.
Patients with large cell lymphoma
(except for T-cell phenotype) who are
previously untreated and have a tumor
risk score of <3 are eligible. Patients
must have adequate marrow reserve
(ANC, >1000/mm3; platelets, >100,000/
mm3), unless lymphoma is cause of low
counts. Serum creatinine and bilirubin
must each be <2 mg/dL.
FOR MORE INFORMATION about these clinical
trials, physicians or patients should call
the M. D. Anderson Information Line.
Those in the United States, call (800)
392-1611; those in Houston or outside
the United States, call (713) 792-6161.
Visit the M. D. Anderson Cancer Center
clinical trials Web site at http://
www. clinicaltrials. org.4 / MD Anderson OncoLog
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University of Texas M.D. Anderson Cancer Center. MD Anderson OncoLog, Volume 43, Number 8, August 1998, periodical, August 1998; Houston, Texas. (https://texashistory.unt.edu/ark:/67531/metapth903558/m1/4/: accessed April 25, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.