Sonali Smith, MD: An Update On Treatment for Non-Hodgkin’s Lymphoma

Sonali Smith, MD gives an update on a Non-Hodgkin’s lymphoma paper presented at ASCO 2011.

Dr. Smith is Associate Professor of Medicine at the University of Chicago Medical Center.  She is an expert in the care and treatment of adults with all types of Hodgkin and non-Hodgkin lymphoma. She has a special interest in new agents for lymphoma, as well as stem cell transplantation and its role in improving the survival of patients with relapsed lymphomas.

The Group Room at the 2011 American Association For Cancer Research Annual Meeting was made possible, in part, by:



Selma R. Schimmel, Founder & CEO, Vital Options International:

This is Selma Schimmel at ASCO 2011.  Conversations are going on here and now we’re going to sit with Dr. Sonali Smith who was with us last year.  You are Associate Professor of Medicine, University of Chicago Medical Center; you are also a member of the ASCO Cancer Communications Committee.  I want to welcome you back.

Sonali Smith, MD, Associate Prof. of Medicine, University of Chicago Medical Center:

Thank you so much for inviting me back, Selma.  I had a lot of fun with this last year and really enjoy being here again.

Selma R. Schimmel:

Let’s just first recap a little bit about the poster session that you moderated here.

Sonali Smith:

So the poster session that was done on Saturday actually summarized about 20 different posters, all of which really looked at new treatments for patients with non-Hodgkin lymphoma.  And just by way of background, non-Hodgkin lymphoma is a very diverse disease.  It’s an umbrella term that covers about 60 different subtypes.  And so, one of the challenges we have with developing new therapies is that it’s really critical to make sure when we’re learning about lymphoma or reading about the studies that we know exactly what subtype they were focused on.  In the poster discussion session there were some new treatments that had been added onto the backbone of standard therapies, and I’ll talk about that in just a moment.  And there were also some other studies that looked at trying to really fine tune which subtype of lymphomas responds to one treatment or another.

So, I’ll start with the first series of posters, which really worked on, or focused on an area called diffuse large B-cell lymphoma.  And diffuse large B-cell lymphoma is the most common type of non-Hodgkin lymphoma that we see and it’s one that is potentially curable.  It’s one where we can realistically talk to our patient about going through treatment and about all-comers, 70% of patients can go through that course of therapy and never have the disease come back.  However, that still leaves us with about a third of patients where it’s a little more challenging.  And so, in the poster discussion session investigators were adding new drugs such as lenalidomide (Revlimid) and bortezomib (Velcade) to the backbone of our chop, which is the standard recipe that we use for these patients, for patients with large cell lymphoma.  And the early results were very promising; in most of the studies that were presented they were focused very much on side effects, making sure that adding another treatment didn’t make it much worse for the patient.  And the preliminary results, at least, look as good, if not a little bit better than our chop alone.  So I think these are very promising.  They really focused in on looking at effects on patients with, what we consider, high risk disease.  And so maybe in the future we can say, our chop is great for the standard diffuse large B-cell lymphoma patient but if they have high risk features maybe we can add in something else.

The other issue with lymphoma that I just want to bring up is that for many years we’ve had debates on the role of transplant.  So bone marrow transplant or stem cell transplant, those words are interchangeable today, is often used when lymphoma comes back.  However, there were three studies in the oral session, all of which tried to use, or at least tested whether or not a transplant up front for patients who are newly diagnosed, helped, or not.  And the rationale there is that, if you wait until the lymphoma comes back before you do a transplant you might have some patients that, their disease is resistant, and so perhaps if we bring up high dose chemotherapy, patients may do better.  And the unifying theme for all three of these studies, which were large international trials; one of them was all US based but included many, many institutions, the other two were in Europe.  All of theme showed that more is not better.  And I think that’s a very important concept for a lymphoma doctor to know that even though a transplant can be done up front, it didn’t really help patients live longer.  So that was very, very important news for us.

Selma R. Schimmel:

You’re on the younger side of the medical oncology community, which means as your career advances it’s your generation that’s really going to just prosper and benefit from all of this.  You are very lucky to be the age you are, at the place you are in medicine.  You have so many years ahead of you to be part of this really dynamic change.