Lymphoma and AIDS-Related Cancer

The Department of Oncology is participating in a national clinical trial evaluating the role of an immunostimulatory agent (CpG ODN) plus rituximab to treat B-cell lymphoma. Rituximab is a monoclonal antibody that is approved for treating patients with B-cell non-Hodgkin’s lymphoma, and is widely used to treat low-grade and intermediate-grade disease. In this trial, a standard dose of rituximab will be combined with CpG ODN. This is an oligonucleotide consisting of cytosine and guanine nucleic acid. Bacterial DNA is rich in CpG repeats, which may confer the immune response associated with bacterial infection. These sites are highly methylated in mammalian DNA, indicating that this is an evolutionary adaptation. Intravenous administration of CpG ODN results in cytokine release and augmentation of immune response in humans and in animals results in better tumor kill when combined with monoclonal antibodies. Eligibility criteria for this study includes patients with B-cell lymphoma who would be candidates for rituximab.

Defining the role of high-dose chemotherapy plus stem cell transplantation in lymphoma 
High-dose chemotherapy plus stem cell transplantation has a proven curative role in patients with relapsed intermediate grade lymphoma, but its role as first-line therapy in high-risk patients remains to be established. Trial S9704 compares 8 cycles of standard CHOP chemotherapy with 5 cycles of CHOP followed by high-dose chemotherapy plus stem cell transplantation. Patients must be less than 66 years of age, have intermediate-grade lymphoma, and have at least two poor risk features (stage III-IV, elevated LDH, ECOG performance status 2, 3, and 4). Patients who have already received one cycle of CHOP are eligible.

Investigating genetic predisposition to cancer
Several genetic mutations are known to be associated with certain cancer types, but this remains elusive for most cancers. Investigators from the Eastern Cooperative Oncology Group are evaluating whether certain genes are associated with cancer predisposition. The study includes 4000 patients with prostate, lung, breast, and colon cancer and their siblings who are also cancer victims. The patient and the living sibling must have the same cancer type. They will both be asked to submit a blood specimen.

HIV Infection and Cancer
Patients with HIV infection are more likely to develop certain types of cancer, including lymphoma and Kaposi’s sarcoma. Montefiore Medical Center is one of 15 sites participating in the AIDS Malignancy Consortium, a NIH-funded clinical trials group devoted to the study of cancer in patients with HIV infection. Novel treatment approaches are available for both diseases, most of which involve treatments that don’t include chemotherapy. Drugs that are currently being evaluated include:

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