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There's an urgent need for effective therapies that have
lower and/or more transient toxicity, because the cumulative affect of
treatment toxicity - particularly myelosuppression - can limit the
range of treatments available to patients with lymphomas and other
cancers.
Myelosuppression is a state of
impaired bone marrow function that results in low blood cell
counts, inadequate immunity leading to increased risk
of infection, and lower tolerance for additional cancer
treatment.
Here we will list approved and investigational
agents that are thought to be less toxic, or that are less
myelosuppressive than standard chemotherapies. Be aware that
toxicity to other organs, such as to the liver and kidneys, can pose
dangers as well
We are *not* advocating for the
avoidance of toxic therapies. Indeed, toxicity alone can be a poor
criterion for selecting a therapy if it leads to under-treating an
aggressive or high-risk lymphoma, for example, that might be cured
with a more aggressive approach.
Therapies with low toxicity
Investigational: BL22
immunotoxin can find tumor cells that express cd22 and kill them
without harming normal cells.
BL22
Immunotoxin in Treating Patients With Refractory Chronic
Lymphocytic Leukemia, Prolymphocytic Leukemia, or Non-Hodgkin's
Lymphoma
Condition: CD22-positive lymphomas and leukemias
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Gallium
Nitrate
Investigational: Gallium
Nitrate (Ganite®) previously received FDA approval as treatment
for cancer-related hypercalcemia. "Gallium nitrate
causes little myelosuppression and is therefore well tolerated by
patients with advanced disease who have received extensive prior
therapy. Given its unique mechanism of action, the high level of
single-agent activity in published clinical trials, the absence of
significant myelosuppression, and the potential lack of
cross-resistance, further clinical study of gallium nitrate both alone
and in combination with other active agents is warranted." ~
Gallium nitrate in the treatment of lymphoma.
Semin Oncol. 2003 Apr;30(2 Suppl 5):25-33. Review. PMID:
12776257
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SEARCH: ClinicalTrials.gov
Idiotype Vaccine
Investigational: Idiotype vaccine
may induce adaptive immunity against lymphoma tumors.
Probable Settings: since this
is an immune therapy, the ideal setting is probably in patients who
are not immune compromised - such as to consolidate response to
early treatment, or early use as an alternative to watchful
waiting.
See Vaccines
Radiofrequency Ablation
(not typically available in clinical practice)
See RFA
Rituxan
Approved for cd20-positive
b-cell lymphomas: Rituxan - binds to cd20 tumor cells.
It can induce cell death directly and/or by "flagging" lymphoma cells
for attack by immune cells.
Salvage therapy for relapsed aggressive NHL?
"Although a higher response is seen in
indolent NHLs, the response rate of patients with relapsed
aggressive NHL to single agent rituximab is 31% (22% partial
remission, 9% complete remission)" ncbi.nlm.nih.gov
See Rituxan
Spirogermanium
Investigational:
Phase I study of spirogermanium
given daily jco.org
"Spirogermanium, an azaspirane compound, has
recently had limited clinical trials using a schedule of intravenous injection one to three times
every week. The observation of clinical antitumor activity and lack of myelosuppression
prompted us to investigate further the clinical effects of spirogermanium
administered on
various schedules. ... Of the 44 assessable patients, 3 demonstrated
a partial response and 3 had minor tumor regression; all responses
occurred in lymphoma patients."
Clinical
Trial - Cancer.gov
OTHER
The
following agents are reported to have favorable toxicity
profiles. Click the agent to start a search.
