open access

Vol 4, No 3 (2008)
Review paper
Published online: 2008-07-03
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Novel agents and new approaches to therapy improve survival of patients with lymphoid malignancies

Jan Walewski
Onkol. Prak. Klin 2008;4(3):93-100.

open access

Vol 4, No 3 (2008)
REVIEW ARTICLES
Published online: 2008-07-03

Abstract

Probability of long-term survival of patients with lymphoid malignancies improved over past half-century by around 50% with a major progress seen in the last decade. It is also true for indolent diseases, until recently regarded as incurable. Introduction of monoclonal anti-CD20 antibody (rituximab) to induction treatment of B-cell lymphomas - aggressive as well as indolent, lead to statistically significant and clinically relevant improvements in all efficacy measures: response rate, progression free survival, and overall survival withantyout additional expense on toxicity. In case of highly aggressive Burkitt's lymphoma, a combination of ritu ximab with alternating dosing of antimetabolites and fractionated alkylating agents lead to cure rates of 90% order of magnitude in young patients, and around 80% - in the elderly. Ability of monoclonal antibodies (anti-CD20 and anti-CD52) to eradicate lymphoma cells from circulation and bone marrow (minimal residual disease negativity) revived radical approaches to treatment of indolent lymphoma, including chronic lymphocytic leukemia. These approaches involve aiming at complete remission, and assume a cure as a realistic goal of therapy. Recognition of prognostic importance of complete or nearly complete remission recently returned with current advances in therapy of multiple myeloma. Marked improvement in overall survival of multiple myeloma patients seen in population based registries since the beginning of the 90-ties is in parallel to general adoption of high-dose chemotherapy and autologous hematopoietic cell transplantation, a procedure known to substantially increase the rate of complete remission in myeloma. In addition, new agents of proven anti-myeloma activity in monotherapy and improving efficacy of multidrug combinations entered clinical trials and general practice (thalidomide, bortezomib, lenalidomide). These agents that interfere with regulatory mechanisms of apoptosis and cell cycle are subject to current clinical trials in a number of lymphoma entities where conventional treatment is largely ineffective.

Abstract

Probability of long-term survival of patients with lymphoid malignancies improved over past half-century by around 50% with a major progress seen in the last decade. It is also true for indolent diseases, until recently regarded as incurable. Introduction of monoclonal anti-CD20 antibody (rituximab) to induction treatment of B-cell lymphomas - aggressive as well as indolent, lead to statistically significant and clinically relevant improvements in all efficacy measures: response rate, progression free survival, and overall survival withantyout additional expense on toxicity. In case of highly aggressive Burkitt's lymphoma, a combination of ritu ximab with alternating dosing of antimetabolites and fractionated alkylating agents lead to cure rates of 90% order of magnitude in young patients, and around 80% - in the elderly. Ability of monoclonal antibodies (anti-CD20 and anti-CD52) to eradicate lymphoma cells from circulation and bone marrow (minimal residual disease negativity) revived radical approaches to treatment of indolent lymphoma, including chronic lymphocytic leukemia. These approaches involve aiming at complete remission, and assume a cure as a realistic goal of therapy. Recognition of prognostic importance of complete or nearly complete remission recently returned with current advances in therapy of multiple myeloma. Marked improvement in overall survival of multiple myeloma patients seen in population based registries since the beginning of the 90-ties is in parallel to general adoption of high-dose chemotherapy and autologous hematopoietic cell transplantation, a procedure known to substantially increase the rate of complete remission in myeloma. In addition, new agents of proven anti-myeloma activity in monotherapy and improving efficacy of multidrug combinations entered clinical trials and general practice (thalidomide, bortezomib, lenalidomide). These agents that interfere with regulatory mechanisms of apoptosis and cell cycle are subject to current clinical trials in a number of lymphoma entities where conventional treatment is largely ineffective.
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Keywords

lymphomas; chronic lymphocytic leukemia; myeloma; immunochemotherapy; autotransplantation; rituximab; alemtuzumab; thalidomide; lenalidomide; bortezomib

About this article
Title

Novel agents and new approaches to therapy improve survival of patients with lymphoid malignancies

Journal

Oncology in Clinical Practice

Issue

Vol 4, No 3 (2008)

Article type

Review paper

Pages

93-100

Published online

2008-07-03

Bibliographic record

Onkol. Prak. Klin 2008;4(3):93-100.

Keywords

lymphomas
chronic lymphocytic leukemia
myeloma
immunochemotherapy
autotransplantation
rituximab
alemtuzumab
thalidomide
lenalidomide
bortezomib

Authors

Jan Walewski

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