Recent Advances in Non-Hodgkin’s Lymphoma

By Dr Dr Lim Soon Thye, Associate Consultant
Dept of Medical Oncology, NCC

Each year, the National Cancer Center sees about 150 to 200 patients with Non-Hodgkin’s Lymphoma (NHL), a type of cancer involving the body’s immune system. In up to 90% of NHL, the cancers involve the B-lymphocytes (white blood cells) and are therefore called B-cell NHL. About two-thirds of these patients have an aggressive form of the disease, which if left untreated will result in death in less than 6 months. Over the last three decades, patients with this condition have received fairly successful treatment with a chemotherapy regimen comprising of Cyclophosphamide, Doxorubicin, Oncovin (vincristine) and Prednisolone, often called CHOP. Despite treatment, about 40% of patients still suffer a relapse of lymphoma.

Fortunately, researchers recently found that they could improve upon the efficacy of CHOP with the additional use of a new drug known as Rituximab, a monoclonal antibody designed specifically to target a particular protein - the CD20 antigen - on the surface of cancerous B-lymphoma cells. After binding to the cancerous lymphoma cells, it triggers the body's immune system to kill the cancerous cells. Both stem cells and other healthy cells in the body that lack the CD 20 antigen are thus spared. Consequently, treatment with Rituximab is usually well tolerated, without the unpleasant side effects like conventional chemotherapy.

In a landmark study from France, first published in the New England Journal of Medicine in 2002 and recently updated, researchers reported that for elderly patients (60 to 80 years old) with aggressive B-cell NHL, treatment with Rituximab plus CHOP (R-CHOP) was better than using CHOP alone. There was a higher response to treatment with R-CHOP. In addition, about 70% of patients treated with R-CHOP were alive after 2 years, compared to only 57% in those treated with CHOP alone. The overall survival after 5 years also favoured R-CHOP.

More recently, the benefit of R-CHOP has also been shown in younger patients. In one recently completed international study, 85% of patients treated with Rituximab plus chemotherapy achieved a complete remission compared to only 65% in those treated with chemotherapy alone. Additionally, of those treated with this combination, 81% were free of their disease after two years, compared to 58% of those treated with chemotherapy alone.

Based on these data, Rituximab plus chemotherapy should now be the standard first-line treatment of all patients suffering from this aggressive B-cell NHL.