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New Strategy Helps Young Lymphoma Patients

Approach resulted in high remission rates without the risks tied to radiotherapy, researchers say


The NIH trial involved 51 patients with untreated primary mediastinal B-cell lymphoma who were followed over the course of 14 years. The largest tumor diameter of any patient in the study was 11 centimeters.

Each patient received a regimen of drugs known as dose-adjusted EPOCH-R. The regimen included the following drugs: etoposide, doxorubicin, cyclophosphamide, vincristine, prednisone and rituximab. The dosages of these drugs were adjusted to make them as effective as possible.

In the study, only two patients who received this dose-adjusted chemotherapy treatment did not go on to achieve complete remission. These two patients, the researchers noted, also received radiation and have not had their tumors come back.

Meanwhile, none of the patients who did achieve a complete remission experienced disease recurrence. The researchers added there were no signs of heart damage or other long-term negative health effects among the patients.

"The high success of this regimen in greatly reducing the need for radiation and improving the cure rate in this disease may relate to specialized dosing and continuous infusion delivery of the EPOCH-R agents," explained lead researcher Dr. Wyndham Wilson, head of the NCI's Lymphoma Therapeutics Section.

Wilson and his colleagues also collaborated with researchers at Stanford University who used the regimen to treat their own group of 16 slightly older patients with primary mediastinal B-cell lymphoma. The Stanford study found all 16 patients who received the dose-adjusted chemotherapy regimen achieved full remission and none of them required radiation.

Other experts were optimistic about the research.

"What is encouraging is the fact that so many patients did well without radiotherapy, which will reduce the risk these patients have of developing late complications, including secondary solid tumors, acute leukemia and cardiac disease," said Dr. Jonathan Kolitz, associate chief of hematological oncology at the North Shore-LIJ Cancer Institute in Lake Success, N.Y. He stressed, however, that more research needs to be done to confirm that the new approach "is truly superior to the more conventional administration" used today.

Dr. Alan Astrow is director of hematology/medical oncology at Maimonides Cancer Center in New York City. He called the findings "highly impressive results."

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