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Cancer Resources > Cancer News > Cancer News from Reuters > Reuters Cancer News > 2005 > July
Specific regimen influences risk of myelodysplasia after lymphoma treatment
Last Updated: 2005-07-29 14:14:26 -0400 (Reuters Health)
NEW YORK (Reuters Health) - In patients treated for lymphoma, treatment-related myelodysplasia can occur even after chemotherapy with non-DNA-damaging agents but may be less common after initial therapy with tositumomab-based radioimmunotherapy, according to two reports in the June 15th issue of Blood.
In the first report, Dr. Peter McLaughlin from University of Texas M.D. Anderson Cancer Center, Houston, and colleagues describe the occurrence of treatment-related myelodysplasia (t-MDS) and acute myeloid leukemia (AML) in 8 patients with indolent lymphoma who received fludarabine, mitoxantrone, and dexamethasone (FND), with or without rituximab, followed by interferon-alpha.
All 8 patients had cytogenetic abnormalities commonly seen after alkylating agent therapy, the authors report, including abnormalities of chromosome 5 and/or 7 in 6 patients.
Median survival after developing t-MDS or AML was 9 months, the results indicate.
Treatment-related MDS occurring 1 to 5 years after therapy "must be considered a risk of FND or rituximab-FND plus interferon-alpha therapy, particularly if protracted treatment is given," the authors conclude.
In the second report, Dr. John M. Bennett from University of Rochester School of Medicine, New York, and associates investigated the incidence of t-MDS and AML in patients with non-Hodgkin lymphoma treated with tositumomab or iodine-131 tositumomab.
AML or MDS developed in 1.6% of more than 1000 patients, the authors report, including 1.4% of those previously treated but none of those who received radioimmunotherapy as initial treatment for their lymphoma.
Patients who received fludarabine-containing regimens and patients with platelet counts below 150,000/mm³ were about 3 times as likely as other patients to develop treatment-related MDS or AML, the report indicates.
In contrast, the investigators report, none of the 76 patients with previously untreated, advanced-stage follicular large granular non-Hodgkin lymphoma (LG-NHL) who received tositumomab and I131 tositumomab as initial therapy developed t-MDS or t-AML over the 4.6 years of median follow-up.
"While longer follow-up is needed," the authors conclude, "these results suggest that radioimmunotherapy will, with acceptable toxicity, take its place among the more effective therapies for LG-NHL."
Dr. Leo I. Gordon from Northwestern University Feinberg School of Medicine, Chicago, Illinois, writes in a related commentary: "Since many new agents, including fludarabine and radioimmunotherapy, are now available off the shelf, we are obligated to follow the lead of the investigators in (these 2 reports) and test new agents and combinations in the context of carefully monitored clinical trials, in order to study the biological and clinical implications of our actions."
Blood 2005;105:4573-4575,4576-4582,4543-4544.
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