Improving treatments for non-Hodgkin lymphomas

Clinicians and scientists at UCL have been central to the design and management of single centre and multi-centre lymphoma trials within the UK and internationally. These trials have improved the treatment of non-Hodgkin lymphoma, resulting in improved patient survival, quality of life and more appropriate use of resources.

The non-Hodgkin lymphomas (NHL) are malignancies of the cells of the lymphoid system. They are the sixth most common cause of cancer and the reported incidence has risen dramatically over the last 40 years. There are many different types of NHL with variable speeds of progression, response to treatment and ultimate cure rates. Research at the UCL Cancer Institute has changed the way patients with various different forms of NHL are managed in the UK and worldwide. This work has resulted in improved patient survival, quality of life and appropriate resource utilisation.

In aggressive NHL we established the role of autologous stem cell transplant (ASCT) in patients who relapse after primary chemotherapy. This regimen has been the mainstay of treatment for relapsed NHL for over two decades. The researchers' subsequent studies have confirmed that relapsed patients are the most appropriate candidates for ASCT as there is no advantage to using ASCT earlier in the treatment path.

There have been enormous advances in the treatment of NHL but further improvements are still required. There is no room for complacency. New approaches are becoming available for both first and second line therapies and UCL/UCLH is actively exploring these options. - Professor David Linch

In indolent NHL, the group showed that for asymptomatic patients, a policy of watchful waiting allows chemotherapy to be postponed by an average of two and a half years with no reduction in survival rates. This became standard care for the 30-40% of all follicular lymphoma patients who are asymptomatic at the time of diagnosis. Subsequently in 2010 the team reported on results of a trial to compare rituximab therapy with watchful waiting. They found that treatment with rituximab has advantages over watchful waiting: at three years, 54% of patients in the watch-and-wait arm had required chemotherapy compared to only 18% in the rituximab arm and there was improved quality of life. As a result, since this work was presented in abstract form in 2010, monotherapy with rituximab alone is now widely used in this situation.

Lastly, for patients who relapse after ASCT, the researchers refined optimal usage of allogenic stem cell transplantation, where the stem cells are from a donor rather than the patient's own. This procedure had previously been too toxic to use in NHL, so they developed a reduced-intensity treatment which has greatly reduced the toxicity and mortality associated with allogeneic transplantation.

Key funders included CRUK, Leukaemia and Lymphoma Research and the Lymphoma Research Trust.