Doctors wait for relapse before treating with high-dose chemotherapy and stem cell transplant because a significant number of patients will be cured by standard-dose treatment the first time around.

Herman Kattlove, MD, an oncologist and medical editor for the ACS, says both of these studies help point out the role of high-dose therapy and autologous stem cell transplant in non-Hodgkin?s lymphoma. "Patients should first be given standard therapy," he says. "If they don?t go into remission or they relapse later on, then they should be offered the transplant. High-dose chemotherapy and stem cell transplant is clearly the best hope for a cure for these patients."

In high-dose chemotherapy and autologous stem cell transplantation, the patient?s stem cells are taken from either their bone marrow or blood, and then stored. The patient then receives high doses of chemotherapy, which kills the cancer cells as well as all the blood cells, including the stem cells, in the patient?s bone marrow. After treatment, the stored stem cells are returned to the patient by transfusion (transplant) so they can make new blood cells.

But what if the lymphoma doesn?t respond to the standard chemotherapy at all? About 30% to 50% of patients do not achieve a complete response (no evidence of any cancer remaining). The JCO study found that some of these patients can still beat their cancer with high-dose chemo and autologous stem cell transplant.

Julie Vose, MD, co-author of the JCO study and a professor of medicine, University of Nebraska Medical Center, says it may be better to use the transplant and high-dose therapy in these refractory patients who fail chemo.

In Vose?s study, researchers examined records from 184 patients with diffuse aggressive NHL who were listed in the Autologous Blood and Marrow Transplant Registry. These patients were never able to achieve a complete remission with standard chemotherapy and had therefore received an autologous stem cell transplant.

The patients were followed for an average of 41 months after therapy. After getting the transplant, 44% of the patients had either a complete remission or a complete remission with some abnormal imaging results that did not suggest active cancer. Another 19% of the patients had a partial remission that lasted for a month or more. Thirty-one percent of the patients failed to respond to therapy, having either no response or cancer that worsened. The remaining 6% were not evaluated due to early death.

Researchers determined that 37% of the patients in this study would survive five years or more following therapy and 31% would be free of their lymphoma. "This study confirms that some patients with refractory NHL can achieve long-term, disease-free survival with high-dose chemotherapy and autologous bone marrow transplant," says Harmon Eyre, MD, vice president for research and cancer control at the ACS.

Patients who were 55 or older at the time of transplantation had a poorer prognosis than younger patients did. Despite this, Vose says she recommends transplant regardless of age, if the patient is physically able to have it.