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NIH clinical trials lymphoma

Patients with a type of cancer known as primary mediastinal B-cell lymphoma who received infusions of chemotherapy, but who did not have radiation therapy to an area of the thorax known as the mediastinum, had excellent outcomes, according to clinical trial results. Until now, most standard treatment approaches for patients with this type of lymphoma have included radiation therapy to the mediastinum. However, mediastinal radiation is associated with substantial long-term toxic side effects.

The results of this single arm trial, which followed 51 patients for a period of up to 14 years, was conducted by researchers at the National Cancer Institute (NCI), part of the National Institutes of Health, and appeared April 11, 2013, in The New England Journal of Medicine.

Primary mediastinal B-cell lymphoma mainly affects people from their teenage years to their early 30s. Many patients are cured with a combination of chemotherapy and radiation therapy. However, even with this treatment, about 20 percent of patients see their disease progress.

Most patients receive radiation to the chest area, which can cause new cancers as well as damage to the heart. This is particularly a problem for young people because the risk of new cancers and heart disease continues to increase as they get older. Primary mediastinal B-cell lymphoma is also more common in women, who are at greater risk of developing breast cancer from radiation therapy to the chest.

Wyndham Wilson, M.D., Ph.D., head of NCI’s Lymphoma Therapeutics Section, and colleagues conducted the trial, in which every patient received the drugs etoposide, doxorubicin, cyclophosphamide, vincristine, prednisone, and rituximab in a regimen known as dose-adjusted EPOCH-R, or DA-EPOCH-R. This regimen uses infusion strategies in which doses of the drugs etoposide, doxorubicin, and cyclophosphamide are adjusted for greatest efficacy.

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