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Non-Hodgkin's Lymphoma

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Treatment for Aggressive, Recurrent Adult NHL

    Standard Treatment Options for Aggressive, Recurrent Adult NHL

    Standard treatment options for aggressive, recurrent adult non-Hodgkin lymphoma (NHL) include the following:

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    Understanding Non-Hodgkin Lymphoma -- the Basics

    Lymphoma refers to a malignancy of the lymphatic system. The lymphatic system is a network of nodes (knots of tissue) connected by vessels. Together, the lymph nodes drain fluid and waste products from the body. The lymph nodes act as tiny filters, removing foreign organisms and cells. Lymphocytes, are a type of white blood cell that helps fight  infections caused by  bacteria, viruses, or fungi. The lymph node function is to prevent infections from entering the bloodstream. When the lymphatic system...

    Read the Understanding Non-Hodgkin Lymphoma -- the Basics article > >

    1. Bone marrow or stem cell transplantation.
    2. Re-treatment with standard agents.
    3. Palliative radiation therapy.

    Bone marrow or stem cell transplantation

    Bone marrow transplantation (BMT) is the treatment of choice for patients whose lymphoma has relapsed.[1] Preliminary studies indicate that approximately 20% to 40% of patients will have a long-term disease-free status, but the precise percentage depends on patient selection and the specific treatment used. Preparative drug regimens have varied; some investigators also use total-body irradiation. Similar success has been achieved using autologous marrow, with or without marrow purging, and allogeneic marrow.[2,3,4,5,6]

    Evidence (bone marrow transplantation):

    1. In a prospective, randomized study, known as the EORTC-PARMA trial, 215 patients in first or second relapse of aggressive lymphoma, younger than 60 years, and with no bone marrow or central nervous system involvement, were given two cycles of intensive combination chemotherapy. The 109 patients who responded were randomly assigned to receive four more cycles of chemotherapy and involved-field radiation therapy (IF-XRT) versus autologous BMT followed by IF-XRT. With a 5-year median follow-up, the event-free survival (EFS) was significantly improved with transplantation (46% vs. 12%). Overall survival (OS) was also significantly better with transplantation (53% vs. 32%).[7][Level of evidence: 1iiA] Salvage BMT was unsuccessful for patients on the nontransplant arm whose disease relapsed.

      In general, patients who responded to initial therapy and who have responded to conventional therapy for relapse prior to the BMT have had the best results.[8]

    2. In a prospective trial, patients who relapsed late (>12 months after diagnosis) had better OS than patients who relapsed earlier (8-year survival was 29% vs. 13%, P = .001).[9][Level of evidence: 3iiiA]

    Peripheral stem cell transplantation has yielded results equivalent to standard autologous transplantation.[10,11] Even patients who never experienced complete remission with conventional chemotherapy may have prolonged progression-free survival (31% at 5 years) after high-dose chemotherapy and hematopoietic stem cell transplantation if they retain chemosensitivity to reinduction therapy.[12][Level of evidence: 3iiiDiii] Some patients who relapse after a previous autologous transplantation can have durable remissions after myeloablative or nonmyeloablative allogeneic stem cell transplantation.[13,14]; [15][Level of evidence: 3iiiDiv]

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