{"id":26138,"date":"2020-07-01T12:00:00","date_gmt":"2020-07-01T12:00:00","guid":{"rendered":"https:\/\/www.cancer.gov\/news-events\/cancer-currents-blog\/2020\/rituximab-childhood-b-cell-lymphoma-more-cures"},"modified":"2024-11-03T15:16:45","modified_gmt":"2024-11-03T15:16:45","slug":"new-drug-regimen-cures-more-children-with-aggressive-b-cell-lymphoma","status":"publish","type":"post","link":"https:\/\/ogkologos.com\/en\/new-drug-regimen-cures-more-children-with-aggressive-b-cell-lymphoma\/","title":{"rendered":"New Drug Regimen Cures More Children with Aggressive B-Cell Lymphoma"},"content":{"rendered":"

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The results from a recent study establish a new standard for treating children and young adults newly diagnosed with fast-growing forms of B-cell non-Hodgkin lymphoma, including Burkitt lymphoma.<\/p>\n

In the study, adding the drug rituximab (Rituxan, Truxima)<\/a> to standard chemotherapy improved the overall cure rate in these patients from approximately 87% to 95%<\/a>.<\/p>\n

The new treatment regimen \u201cis a remarkably effective therapy for a group of children who have a very aggressive<\/a> form of lymphoma,\u201d said Malcolm Smith, M.D., Ph.D., of NCI\u2019s Cancer Therapy Evaluation Program<\/a>, who was not involved in the study.<\/p>\n

\u201cTo achieve 95% survival for these patients is an outstanding result and a very important accomplishment,\u201d Dr. Smith added.<\/p>\n

Findings from the international study, which was led by the NCI-supported Children\u2019s Oncology Group<\/a> and the European Intergroup for Childhood Non-Hodgkin Lymphoma, were published June 4 in the New England Journal of Medicine<\/em>.<\/p>\n

Moving the Needle on Survival Rates<\/h2>\n

Childhood non-Hodgkin lymphoma is a disease in which cancer cells form in the lymph system<\/a>, which is part of the body\u2019s immune system<\/a>. B-cell non-Hodgkin lymphoma begins in white blood cells called B lymphocytes<\/a>. In children, B-cell non-Hodgkin lymphoma is often a very aggressive, fast-growing disease, and most cases are Burkitt lymphoma, said Thomas Gross, M.D., Ph.D., of Children\u2019s Hospital Colorado, one of the lead authors on the new study.<\/p>\n

The development of intensive chemotherapy<\/a> regimens for pediatric Burkitt lymphoma, which use high doses of cancer drugs given over several months, increased the cure rate for these relatively rare cancers from about 30% in the 1970s to 85% in the 1990s for children with the most serious cases, Dr. Gross said.<\/p>\n

\u201cBut to get those kinds of improvements we had to really intensify the chemotherapy,\u201d and any further intensifying could lead to more treatment-related deaths, he continued. So, to further improve treatment outcomes, researchers needed to find and test less-toxic drugs that could be given in addition to chemotherapy.<\/p>\n

Rituximab\u2014a type of immunotherapy<\/a> that targets cancerous B cells as well as normal B cells\u2014was a good candidate because earlier studies showed that adding this drug to chemotherapy helped adults with B-cell lymphoma live longer, Dr. Gross explained.<\/p>\n

Benefits of Adding Rituximab Are Clear<\/h2>\n

To enroll enough children with B-cell lymphomas in the type of large clinical trial needed to rigorously test the potential benefit of adding rituximab to chemotherapy, Dr. Gross and his colleagues forged a collaboration involving a dozen countries in North America, Europe, Asia, New Zealand, and Australia.<\/p>\n

Patients ranging from 2 to 17 years old were randomly assigned to receive either the standard regimen of intensive chemotherapy or the same chemotherapy regimen plus six doses of rituximab given over the course of treatment.<\/p>\n

Researchers had originally planned to enroll about 600 patients in the study. However, it was stopped early, after enrolling only 328 patients, because a preplanned interim analysis of patient data showed such a clear benefit for rituximab. Halting the trial meant that the randomized<\/a> part of the trial was stopped and all children who were not receiving rituximab were allowed to receive it, Dr. Smith said.<\/p>\n

Of the 328 patients randomly assigned to chemotherapy only or to chemotherapy plus rituximab, 287\u2014or nearly 90%\u2014had Burkitt lymphoma. Three years after starting treatment, the event-free survival<\/a> rate was 82% with chemotherapy alone and 94% with chemotherapy plus rituximab. Event-free survival means that these patients had not seen any sign of their cancer\u2019s return or progression, developed a second cancer, or died from any cause.<\/p>\n

The percentage of patients still living after 3 years (overall survival<\/a>) was 87% with chemotherapy alone and 95% with rituximab plus chemotherapy. Children with aggressive B-cell lymphoma who survive for 3 years without the disease coming back are generally considered cured, Dr. Smith said.<\/p>\n

Most Side Effects Are Temporary<\/h2>\n

Severe side effects, such as infections and febrile neutropenia<\/a>, occurred in 24% of patients in the chemotherapy-only group and 33% of patients in the rituximab\u2013chemotherapy group.<\/p>\n

Three patients in each group died from treatment-related effects. However, Dr. Smith said, \u201cmost children were able to tolerate the treatment, and most of the side effects were reversible.\u201d<\/p>\n

\u201cChildren who received rituximab had more infections during treatment, but we were able to treat them successfully,\u201d Dr. Gross said. \u201cBecause rituximab attacks normal B cells as well as tumor B cells, it will be important to follow these children long term to make sure that their immune systems return to normal function.\u201d<\/p>\n

Results from the Childhood Cancer Survivor Study published last year show that the intensive chemotherapy regimen used to cure children with aggressive B-cell non-Hodgkin lymphoma does not have many long-term effects that would affect a person\u2019s quality of life<\/a>, Dr. Gross noted. <\/p>\n

Challenges for Treatment in Low- and Middle-Income Countries<\/h2>\n

Despite the high cure rate achieved by adding rituximab to chemotherapy, Dr. Gross said, \u201cwe still need to find treatments for the 5% of patients who aren\u2019t cured with this therapy,\u201d because once the disease comes back there are no good treatment options.<\/p>\n

In addition, he noted, only about 10% of all children worldwide who have Burkitt lymphoma and other aggressive B-cell lymphomas live in countries that have sufficient resources to allow them to get potentially curative treatments and the supportive care<\/a> needed to manage severe side effects of intensive chemotherapy. Burkitt lymphoma has been linked to infection with the Epstein-Barr virus<\/a>, particularly in Africa, where this virus causes most cases of the disease.<\/p>\n

Cure rates for children with aggressive B-cell lymphomas are markedly lower in low- and middle-income countries (LMICs) than in high-income countries like the United States, said Monika Metzger, M.D., of the Department of Global Pediatric Medicine at St. Jude Children\u2019s Research Hospital. <\/p>\n

In Central America, for example, inadequate supportive care results in more patients dying from treatment-related complications, while others die due to abandonment of therapy or from disease that comes back because the intensive therapy needed for a cure could not be administered, she said. <\/p>\n

\u201cIt is conceivable that the addition of rituximab could allow for a reduction of [toxic] chemotherapy\u201d in children with non-Hodgkin lymphoma, the study authors wrote. But more data are needed before that possibility can be explored.<\/p>\n

\u201cTrials in LMICs, where very intensive chemotherapy is not tolerated and more than 10% of patients die from toxicity, could provide an opportunity to examine which patients can be cured with less intense chemotherapy when rituximab is added,\u201d Dr. Metzger said.<\/p>\n

Unfortunately, she noted, rituximab is either not readily available or unaffordable in many LMICs. \u201cThis needs to change, so that all children with an otherwise highly curable cancer have access to a potential cure,\u201d she concluded.<\/p>\n

Source<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

July 1, 2020, by NCI Staff The results from a recent study establish a new standard for treating children and young adults newly diagnosed with fast-growing forms of B-cell non-Hodgkin lymphoma, including Burkitt lymphoma. In the study, adding the drug rituximab (Rituxan, Truxima) to standard chemotherapy improved the overall cure rate in these patients from […]<\/p>\n","protected":false},"author":2,"featured_media":26139,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"footnotes":""},"categories":[5137],"tags":[],"class_list":["post-26138","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-world-news"],"_links":{"self":[{"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/posts\/26138","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/comments?post=26138"}],"version-history":[{"count":1,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/posts\/26138\/revisions"}],"predecessor-version":[{"id":45629,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/posts\/26138\/revisions\/45629"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/media\/26139"}],"wp:attachment":[{"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/media?parent=26138"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/categories?post=26138"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/tags?post=26138"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}