Guest Blogger: Alice Pettaway
For people suffering from primary mediastinal B-cell lymphoma, the future may seem bleak. Fortunately, the latest results from a clinical trial offers hope for patients fighting lymphoma.
What is primary mediastinal B-cell lymphoma?
Primary mediastinal B-cell lymphoma (PMBL) is a type of lymphoma that forms in the mediastinum. PMBL predominantly affects young people (more commonly women than men) from the teenage years until the 30’s. Although many patients can be cured using a combination of chemotherapy and radiation therapy, about 20% of patients still see a progression of the disease.
Traditionally, patients with primary mediastinal B-cell lymphoma were treated with radiation therapy to the mediastinum. Unfortunately, the practice of applying radiation therapy to the mediastinum is dangerous because of its long-term toxic side effects. For example, the risk of heart disease and new cancers steadily increase as the patients become older. However, according to clinical trial results, it has been found that avoiding the mediastinum during chemotherapy actually provides better outcomes for the patients.
The Clinical Test
A clinical test was conducted by the researchers at the National Cancer Institute (NCI) that followed 51 patients for up to 14 years, and the results were published in The New England Journal of Medicine on April 11th, 2013.
In the phase II study, 51 patients with untreated PMBL were included with a maximum tumor diameter of 11 centimeters. All of the patients except two achieved a complete remission with the use of DA-EPOCH-R therapy. Additionally, there has not been any development of recurrent lymphoma in patients that had complete remission. The two patients that did not achieve complete remission still received radiation and did not have any recurring tumors as well. In the clinical test, there was also no evidence of cardiac toxic effects or other diseases developing afterward.
The high success of the tested regimen greatly reduces the need for radiation. Improving the cure rate of PMBL may be related to continuous infusion delivery of EPOCH-R agents and specialized dosing.
Following the clinical test, the researches collaborated with Stanford University (Calif.) Medical Center investigators in order to get an independent assessment of the DA-EPOCH-R results. For the assessment, the regimen was used to treat 16 patients that also had PMBL. The patients treated were similar to those in the NCI study except for having a lower frequency of the disease (outside the mediastinum) and being slightly older. The results from the study showed that the 16 patients that received the regiment also achieved remission and did not require radiation treatment.
The studies suggest that the treatment of PMBL has a better outcome with the use of dose-intense regiments. Additional studies have also shown that using rituximab in the drug regiment may also improve the treatment as well, which is why DA-EPOCH-R has been used instead of just EPOCH.
The results from the tests show that a majority of the patients affected by PMBL can potentially be cured and that the use of radiation may not be necessary. While the regimen is currently being tested internationally, it can prove to be excellent news for those fighting with PMBL (and potentially cord blood banking companies treating related diseases).
Before trying new treatments, it is always recommended to speak with your doctor about all of the risks involved. Your doctor will be able to work with you to best determine what is right for your unique needs.
About the Author
Alice Pettaway is a cord blood nurse. Her articles mainly appear on health blogs where she enjoys sharing her expertize.