Dr. Sunil Gandhi, Cancer & Blood Disease, 07/24/12

I recently saw an 82-year-old patient. She noticed a lump inside her mouth on the upper part called the hard palate.

It was increasing in size, so a biopsy was done. It showed mantle cell non-Hodgkin’s lymphoma.

She had a bone marrow biopsy as an outpatient in my office. Lymphoma involved the bone marrow too. A PET/CT scan showed enlarged lymph nodes in her chest, abdomen and pelvis. Her lymphoma is stage IV.

This sounds like a very bad prognosis, but lymphoma responds very well to chemotherapy.

Lymphoma can be Hodgkin’s or non-Hodgkin’s. Mantle-cell is a non-Hodgkin’s lymphoma (NHL).

This is an aggressive subtype of NHL affecting about 7 percent of people with NHL. It most often appears in people older than 60. It usually involves the bone marrow, lymph nodes, spleen and gastrointestinal system (esophagus, stomach, intestines).

Since this is an aggressive lymphoma, in the past we used to give aggressive chemotherapy. In the recent largest oncology conference in Chicago, an excellent study was presented.

A drug that languished for years behind the Iron Curtain should replace aggressive chemotherapy as the standard of care, as per a researcher in the conference.

Bendamustine (Treanda) is both more effective and less toxic than the standard CHOP regimen when both are combined with rituximab (Rituxan), according to Mathias Rummel, M.D., Ph.D., of University Hospital in Giessen, Germany.

Bendamustine, an alkylating agent, was first discovered 50 years ago, Rummel noted, but was unknown in the West until the fall of the Berlin Wall. Since then, it has been approved in the United States.

The study consisted of almost 550 patients who were randomized to receive either CHOP or Bendamustine. Both groups also received one targeted therapy called Rituxan. Both regimens worked very well with response in excess of 90 percent. The patients were followed for almost four years.

The most important difference was in side effects. Bendamustine does not cause hair loss. And nausea and/or vomiting is also much less common and lowering of blood count is also much less likely. In short, Bendamustine is not only more effective, it is also much better tolerated, giving much better quality of life.

My patient is 82 years old, but she is fairly active and does not have significant comorbid condition. I am offering her treatment with Bendamustine. I am sure she will tolerate this well. This will improve not only her survival, but also quality of life. Research like this impacts cancer care right away.

Dr. Sunil Gandhi is a hematologist and oncologist. He is volunteer medical adviser of the Citrus Unit of American Cancer Society. Write to 521 N. Lecanto Highway, Lecanto, FL 34461, email sgandhi@tampabay.rr.com or call 352-746-0707.