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New immunotherapy cures more children with lymphoma

The treatment of children and adolescents with B-cell non-Hodgkin lymphoma has recently changed definitively. As a result of international research collaboration, with contribution from the Princess Máxima Center for Pediatric Oncology, a new combination treatment consisting of chemotherapy and monoclonal antibody therapy (rituximab) has become the new standard worldwide. This can cure a significant proportion of patients. The results of the study were published in the New England Journal of Medicine on June 4, 2020.
B-cell non-Hodgkin lymphoma, including the Burkitt lymphoma, is the most common form of lymphoma in children. The standard treatment is aggressive chemotherapy which is able to cure many of the patients. The prognosis of a significant group of children affected by the disease remained, however, less favorable. To increase the chance of cure, research was conducted to see whether adding rituximab to standard chemotherapy is safe and more effective than chemotherapy alone. Because the medicine may cause adverse effects, such as prolonged suppression of the immune system an international large-scale randomized study was required to establish the safety and efficacy of rituximab.

Combination
Pediatric oncologist Dr. József Zsiros from the Princess Máxima Center was involved in the study as a clinical researcher. Zsiros: 'Rituximab is a humanized protein made in the laboratory. It binds to the lymphoma cells where it triggers a reaction of the immune system, killing the lymphoma cells. As such, it’s a form of immunotherapy. The drug was promising for the treatment of B-cell lymphomas, but decisive clinical research on efficacy and safety in combination with chemotherapy in children was still lacking. The results of the study are very good. When rituximab is administered with chemotherapy, more than 95% of children and adolescents with advanced Burkitt lymphoma remain alive and disease-free. This new combined therapy increases overall survival by around 10% and reduces the rate of occurrence of an event (death, relapse, tumor progression, second cancer, etc.) by 70%. The combination also proved to be safe. The adverse effects were acceptable and the immune system showed good short-term recovery in almost all patients. The good results also offer the opportunity to further investigate whether we can replace a part of chemotherapy by immunotherapy. This would enable us to reduce adverse effects significantly.'