Lower doses of chemo effective in lymphoma

Hodgkin's lymphoma can be effectively treated with less drugs and radiation, especially in the early stages, finds a new study.

To explain how fewer cycles of chemotherapy and lower dosages of radiation may work just as well as more intensive treatment, researchers at the University Hospital of Cologne have conducted a study involving 1,370 patients with early-stage Hodgkin's lymphoma.

The patients were randomly assigned into four groups: four cycles of chemotherapy followed by either 30 gray (Gy) of radiation; four cycles of chemo plus 20 Gy of radiation; two cycles of chemo followed by 30 Gy of radiation and two cycles of chemo plus 20 Gy of radiation.

The researchers gave patients the standard chemotherapy with four-drug combination containing doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD).

Thereafter, they followed up the patients for five years. On analysing the results the researchers found 91.1 percent of patients in the weakest treatment group with two cycles of chemo and the lesser dosage of radiation had not experienced a relapse, while 93 percent of those in the strongest treatment group with four cycles of chemo and the higher dosage of radiation had relapses.

"The result is very straightforward: there is more toxicity with the more intensive treatment, and there is less toxicity with the less intensive treatment," says author of the study Dr. Andreas Engert, professor of internal medicine, hematology and oncology at the University Hospital of Cologne.

"Even the weakest combination of chemotherapy and radiotherapy was as good as the strongest treatment combination in terms of tumor control," he suggests. Both the chemo and radiation used to treat the disease can cause both short and long-term side effects, says Engert in the study published in the latest issue of the New England Journal of Medicine.

Short-term side-effects of the therapy include hair loss and infections which occurred less often in those who had the less intensive treatment compared to the more intensive treatment. As much as 28 percent of those who had four cycles of chemo lost their hair, compared to 15 percent of those who underwent two cycles.

Hodgkin's lymphoma originates in cells called lymphocytes, which are a part of the immune system.

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