ACCORDING to consultant haematologist Dr Goh Kim Yean, early stage lymphoma responds well to treatment, has good prognosis, good treatment outcomes and good long-term survival.
The most common treatment modalities are chemotherapy, radiotherapy and surgical excision done in combination with chemo or radiotherapy. Depending on the stage and extent of the disease, these treatments can either be given alone or in combination.
Chemotherapy is generally well tolerated and mostly given in the outpatient setting. “Most patients are anxious when they hear about chemotherapy – 'Is it possible for me to avoid chemotherapy?', 'Is it hard to take?', 'Will I have to be in bed or can I move about?'“ observes Dr Goh.
There are side effects of chemotherapy, such as some hair loss, nausea, vomiting and tiredness. “But hair will grow back and new drugs are available to make all the side effects very tolerable,” stresses Dr Goh.
For example, there's treatment to prevent nausea and vomiting (antiemetics), treatment to reduce risk of infections (growth factors) and so on.
“In this day and age, chemo is very tolerable and doctors are able to treat the disease as well as the side effects of therapy to ensure patients are better able to cope with their treatment. This gives patients a better chance of recovery,” she adds.
Immunotherapy is the latest advance in the treatment of lymphoma and was first introduced in the US in 1998 and in Malaysia in 2000.
“The introduction of rituximab (a monoclonal antibody) has improved treatment outcomes in NHL. It is termed the smart bullet because it recognises specific cells which are implicated in B-cell lymphoma, binds to these cells and kills them. When used in combination with chemotherapy, there is a synergistic effect and enhanced tumour kill,” syas Dr Goh.
“Rituximab is effective in all stages of lymphoma. Even patients who have failed on standard chemotherapy can benefit from rituximab treatment,” she adds.
The Groupe d’Etude des Lymphomes de l’Adulte (GELA) conducted a landmark trial in elderly patients (60 to 80 years old), results of which were published in 2002 in the New England Journal of Medicine. It showed that more patients who received a combination of Rituximab with standard chemotherapy achieved complete response (complete resolution of disease) compared to patients who only received conventional chemotherapy.
In 2005, the GELA group published the results of a five-year follow-up of these patients and consistently more patients who received rituximab have remained disease-free compared to the patients who only received conventional chemotherapy.
Another international trial also showed that the addition of rituximab to conventional chemotherapy resulted in a statistically significant improvement in time to treatment failure (TTF) compared to patients who only received conventional chemotherapy.
This trial was halted early because its primary efficacy endpoint (TTF) was met two years earlier than expected. In this study, time to treatment failure (TTF) was defined as documented progressive disease or failure to achieve a complete response rate.
Chemotherapy is generally done once every three weeks and most patients will need six to eight cycles of chemo. Patients will be assessed halfway through treatment and at the end of their treatment schedule to determine response and progress.
At the end of treatment, patients who go into remission will be followed up every few months for a number of years.
Source: The Star
No comments:
Post a Comment