Skip to main content
main-content

28.05.2018 | special report | Ausgabe 2/2018

memo - Magazine of European Medical Oncology 2/2018

My burning issues in aggressive Non Hodgkin’s Lymphoma

Zeitschrift:
memo - Magazine of European Medical Oncology > Ausgabe 2/2018
Autoren:
David Fuchs, Michael A. Fridrik

Summary

Combined-modality treatment with chemo-immunotherapy and radiotherapy produces excellent outcomes in early-stage, non-bulky diffuse large B‑cell lymphoma, and reducing toxicity of therapy is a major concern, especially in elderly patients. In a recent trial, elderly patients with non-bulky (<7.5 cm) in complete metabolic remission after four courses of therapy (rituximab, cyclophosphamide, doxorubicine, vincristine, prednisone [R‑CHOP-14] based) were spared additional chemotherapy and went on to receive four cycles of rituximab only, while all other patients continued on chemo-immunotherapy. The 2‑year overall survival was 98%, which matches historical controls. In another analysis from the same trial, elderly patients with bulky disease in positrone emission tomography (PET) based CR (complete remission) after six cycles of chemo-immunotherapy were spared radiotherapy, while PET-positive patients were irradiated. This approach resulted in a significant reduction (42%) of radiotherapy compared to historical controls without compromising efficacy. Radiotherapy could also be omitted in patients of any age with limited stage, non-bulky disease in another trial, with a 5-year event-free survival of 89% and an overall survival of 92%. Another burning issue is enhancing efficacy in relapsed and refractory diffuse large B‑cell lymphoma. Arguably the most exciting approach in this area is chimeric-antigen-receptor T‑cell therapy. Recent trials have shown nearly 10-fold increases in complete responses compared to historical controls, and most importantly, a high percentage (40%) of durable remissions after one year of follow-up. As in other advances in immunotherapy, toxicity is a major concern. Cytokine release syndrome occurs frequently (1–18% grade 3–4) and management is complex, sometimes requiring admission to intensive care and often including the interleukin-6 receptor antibody tocilizumab.

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

★ PREMIUM-INHALT
e.Med Interdisziplinär

Mit e.Med Interdisziplinär erhalten Sie Zugang zu allen CME-Fortbildungen und Fachzeitschriften auf SpringerMedizin.de. Zusätzlich können Sie eine Zeitschrift Ihrer Wahl in gedruckter Form beziehen – ohne Aufpreis.

Weitere Produktempfehlungen anzeigen
Literatur
Über diesen Artikel

Weitere Artikel der Ausgabe 2/2018

memo - Magazine of European Medical Oncology 2/2018 Zur Ausgabe
  1. Das kostenlose Testabonnement läuft nach 14 Tagen automatisch und formlos aus. Dieses Abonnement kann nur einmal getestet werden.

Neu im Fachgebiet Onkologie

Mail Icon II Newsletter

Bestellen Sie unseren kostenlosen Newsletter Update Onkologie und bleiben Sie gut informiert – ganz bequem per eMail.

Bildnachweise