Vol 4, No 3 (2008)
Review paper
Published online: 2008-07-03
Novel agents and new approaches to therapy improve survival of patients with lymphoid malignancies
Onkol. Prak. Klin 2008;4(3):93-100.
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.
Keywords: lymphomaschronic lymphocytic leukemiamyelomaimmunochemotherapyautotransplantationrituximabalemtuzumabthalidomidelenalidomidebortezomib