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WEDNESDAY, March 24 (HealthDayNews) -- Some patients with an aggressive form of the blood cancer lymphoma can benefit from intensive chemotherapy accompanied by a bone marrow stem cell transplant, a French study finds.

"It is a well-designed and well-executed study, but it is not likely to change our current treatment of lymphoma," says Dr. Paul A. Hamlin, a clinical assistant attending physician and lymphoma expert at Memorial Sloan-Kettering Cancer Center in New York City.

The reason for that restrained response, he says, is that the French physicians tested their regimen against what was the standard therapy when the study began -- CHOP, named for the initials of the four cancer drugs used in the treatment.

But since the completion of another study in January 2002, the old therapy has been supplanted by a treatment that supplements CHOP with rituximab (R-CHOP), a monoclonal antibody that stimulates the immune system to fight the cancer, Hamlin says. A monoclonal antibody seeks a specific target, whereas chemotherapy is a systemic treatment.

"R-CHOP has been the standard approach since then," he says.

Nevertheless, says Dr. Noel Milpied, a professor of hematology at the University Hospital of Nantes and lead author of a report on the study in the March 25 issue of the New England Journal of Medicine, the approach used in France "is appropriate for patients up to the age of 60 with previously untreated lymphoma" who score high on a measure of the cancer's aggressiveness.

The five-year, event-free survival rate (cancer doctors hesitate to use the word "cure") was 74 percent for patients who got the new treatment, consisting of four cancer drugs and the bone marrow transplant, compared to 44 percent for those who got CHOP, the researchers report.

"It is possible that the treatment would be as effective for patients with a less aggressive form of lymphoma, but that has to be checked out," Milpied says. "It is now possible, using a genetic approach, to detect the different kinds of lymphoma."

Hamlin acknowledges the French study "builds upon our experience with bone marrow transplants to find a subset of patients who benefit from this approach."

But the R-CHOP treatment is producing the same long-term results as the regimen tried in France, he says, "and there are ongoing efforts to try to establish the value of bone marrow transplants in the R-CHOP area."

A key point is that lymphoma, a diagnosis once regarded as the end of the road for most patients, is becoming increasingly treatable, Hamlin says.

CHOP treatment brought long-term, disease-free survival to half of the patients who got the therapy, he says. Now the same results can be expected for 75 percent of patients, and there are grounds to hope for even better results.

More information

Lymphoma and its treatments are discussed by the Lymphoma Information Network and the Leukemia & Lymphoma Society.

(SOURCES: Paul A. Hamlin, M.D., clinical assistant attending physician, Memorial Sloan-Kettering Cancer Center, New York City; Noel Milpied, M.D., professor, hematology, University Hospital of Nantes, Nantes, France; March 25, 2004, New England Journal of Medicine)

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