Combination therapy dramatically improves lymphoma patients’ chance of survival

Researchers said the treatment regimen was more effective in lymphoma patients whose disease had already spread to the brain or spine.

An intensive combination treatment of chemotherapy and immunotherapy may “dramatically improve” survival chances of certain blood cancer patients whose disease has spread to the brain or the spine, according to scientists.

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In a study part-funded by Cancer Research UK, researchers have found the treatment regime was more effective in patients who had lymphoma – a type of blood cancer – where the disease had already spread when first diagnosed.

This was when compared with those who had previously been treated for lymphoma and the disease had spread after their cancer had returned.

The researchers said their findings, published in the journal Lancet Haematology, could help in changing the international guidelines on how to treat patients after their lymphoma spreads to their brain or spine, a condition known as secondary central nervous system lymphoma.

While secondary central nervous system lymphoma is rare, it can be lethal.

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A team of researchers led by Dr Kate Cwynarski from University College London Hospital in the UK, and Professor Andrés Ferreri in Milan, Italy, assessed 75 patients across four countries. The research, known as the Marietta study, it is thought to be the largest clinical trial ever to look at secondary central nervous system lymphoma.

Patients on the trial received a combination of chemotherapy and immunotherapy drugs in treatment regimens, known as MATRix and RICE. It included three courses of MATRix followed by three courses of RICE, before a stem cell transplant using cells taken from the patients themselves.

Of the 75 patients assessed, 32 were initially diagnosed when their lymphoma had already spread to their brain or spine and had not received treatment, and 43 had previously been treated for lymphoma and the disease had spread after their cancer came back.

The researchers said the intensive MATRix/RICE treatment prevented the cancer from worsening in 42 (58 per cent) of the patients for at least a year after registering to take part in the trial.

The Marietta trial has meant patients who may have had just months to live are alive and living well years after being diagnosed
Dr Kate Cwynarski

Patients whose lymphoma had spread to the brain or spine when first diagnosed were found to respond to the combination treatment far better than those who had been treated for lymphoma already. In those patients, two-year progression-free survival was reported to be 71 per cent, which, the researchers said, has never been achieved before.

They said the results are “extremely impressive” because they are similar to those who have lymphoma that has not spread to the brain or spine.

According to the researchers, their findings suggest the MATRix/RICE treatment could “dramatically improve survival for patients with secondary central nervous system lymphoma”.

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“The Marietta trial has meant patients who may have had just months to live are alive and living well years after being diagnosed,” said Dr Cwynarski. “It is incredible to be able to sign DVLA forms for many of my patients treated with this approach, as you can’t drive until you have been clear of treatment for two years and are well, which really brought home the impact this study has had.”

Reader Q&A: How does radiation kill cancer if it causes cancer?

Asked by: Odysseus Ray Lopez, US

It’s rather like the way guns can be used to commit crime, or stop it. Radiation causes cancer because its high-energy photons can cause breaks in the DNA strands in your cells. Cells can repair this damage up to a point, but sometimes the repair isn’t perfect and leaves some genes defective.

If the break affects one of the many tumour-suppressing genes in your DNA, that cell can become cancerous. But cancer cells are also more vulnerable to radiation than ordinary cells. Part of what makes them cancer cells is their ability to divide rapidly and this normally means that some of the DNA ‘spellcheck’ mechanisms are turned off.

So when a cancer cell suffers a break in a DNA strand, it’s less likely to repair it correctly. Depending where the break occurs, it might either kill the cell outright, or make it reproduce more slowly.

Radiation therapy uses a focused beam that is aimed at just the part of the body with the tumour, and the dose is carefully calculated to cause the minimum collateral damage to healthy cells. Even so, radiation therapy does very slightly increase your chances of developing a second cancer.

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