Elderly lymphoma patients live longer

Immunochemotherapy followed by maintenance with the antibody rituximab is now providing elderly lymphoma patients with betters prospects for much longer survival.

Lymphoma is typically treated with chemotherapy and antibodies; also called immunochemotherapy. This also applies to the serious and often fatal mantle cell lymphoma, where the common - moderately intensive - treatment has so far not been particularly effective. Therefore, in a major international randomised trial with about 500 patients, researchers have compared first the common immunochemotherapy with more intensive immunochemotherapy, and then maintenance with either antibodies or interferon.

Antibodies ‘post-treat’
The trial showed that the common treatment was actually better than the new treatment, due to fewer side effects, and the fact that antibody maintenance apparently was capable of “clearing up” what was left of the lymphoma after this rather mild treatment. Results are ground-breaking for this type of serious lymphoma, because the majority of patients today are alive and free if disease more than six years after their treatment started.

A European research network, with the participation of the Nordic Lymphoma Group represented by Professor Christian Geisler from the Department of Haematology at Rigshospitalet, is behind this trial, which has just been published in the New England Journal of Medicine; the world’s leading medical journal.

“The results are astounding and extremely positive, and they are a good example of how far we can come by combining chemotherapy with biological agents. Lymphoma often strikes older people, who have difficulties dealing with intensive treatment. Therefore, it is very good news that we are now able to treat them more gently and at the same time more effectively,” says Professor Christian Geisler.

The cancer is attacked on two flanks
At the beginning of the trial, patients drew lots between two types of chemotherapy plus the antibody rituximab; one mild and one strong. The group that responded to this introductory treatment drew lots again between two types of biological maintenance treatment; either with the antibody rituximab again, or with interferon. Both substances work by strengthening the immune system against the lymphoma. Maintenance with interferon only had a modest effect.

Immunochemotherapy attacks the cancer on two flanks: While chemotherapy kills the cancer cells chemically, antibodies call on the immune system to attack the cancer cells as well. Antibodies, which in principle are identical to the ones we form ourselves against germs and virus, hunt down the cancer cells and attach to them, so the immune system perceives the cells as infected and kills them. In this way, antibodies coupled with chemotherapy attack the cancer cells from two sides.

“Immunochemotherapy has proven better than chemotherapy on its own for many different types of lymphoma. The question was now whether the good results with immunochemotherapy could be sustained with maintenance of the antibody, which constantly mobilises the immune system against any remaining cancer cells. This has now been confirmed in mantle cell lymphoma,” says Professor Christian Geisler, who helped design the trial on behalf of the Nordic Lymphoma Group.

These results are a good example of the strength in European - an not least Nordic - research collaboration within lymphoma. However, the results could be even better: The next trial is already about to begin, and its purpose is to establish whether new types of immunochemotherapy and maintenance with new antibodies or biological agents could be even better than those we already know.