Cure lymphoma by combining two advanced techniques

Ho Chi Minh City: A 46-year-old woman with lymphoma relapsed three times. Doctors at Cho Ray Hospital combined bone marrow-destroying chemotherapy with whole-body radiation therapy and stem cell transplantation to help her recover.

The patient, residing in Binh Duong , had lymph nodes in the neck area 6 years ago. The doctor diagnosed him with lymphoma and treated him with chemotherapy. After two years, the disease relapsed. He received chemotherapy for the second time and still responded. Two years ago, the patient relapsed for the third time and this treatment no longer responded.

The patient came to Cho Ray Hospital for examination in July 2022, with a large lymph node mass of about 15 cm, and was diagnosed with follicular non-Hodgkin lymphoma. The disease was resistant to old techniques, so the doctors consulted to find a new treatment direction. The team decided to perform two advanced techniques at the same time, including allogeneic stem cell transplantation combined with a chemotherapy regimen with total body radiotherapy (TBI). Accordingly, the patient received chemotherapy to clear the cancer cells, then total body radiotherapy to clear the remaining cells and then transplant new blood cells.

This is the first time Cho Ray Hospital has performed whole-body radiotherapy. On September 27, Dr. Le Tuan Anh, Director of the Oncology Center, Cho Ray Hospital, said that no public hospital in Ho Chi Minh City has performed whole-body radiotherapy, only one private facility has implemented it and requires foreign doctors to perform it.

Radiation therapy is applied to each organ for solid tumors. In the case of liquid tumors such as leukemia, cancer cells run everywhere, infiltrate the blood vessels, "hide" in the brain, testicles..., only whole-body radiation therapy can destroy them.

Whole body radiotherapy requires accelerators and accessories, and a team of trained personnel. Not long ago, Cho Ray was equipped with 4 accelerators under an Austrian ODA project, thanks to which doctors can deploy the technique.

With stem cell transplantation technique, Cho Ray has been performing for many years. Currently, the whole country has more than 10 stem cell transplant hospitals with more than 1,000 transplanted patients. There are two methods: autotransplantation (taking stem cells from the patient himself to be transfused after chemotherapy) and allogeneic transplantation (also known as allogeneic transplantation, which means taking stem cells from a person who is compatible with the patient to be transfused).

The patient received total body radiotherapy. Photo: Provided by the hospital — The patient received total body radiotherapy. Photo: *Provided by the hospital*

Five months ago, the patient was treated with three consecutive days of total body radiation therapy, then underwent a stem cell transplant from a donor, her 49-year-old sister. After 30 days of stem cell transplantation, the graft grew completely, and the patient was discharged from the hospital after 45 days, instead of having to stay in the hospital for 2-3 months like with stem cell transplantation without radiation therapy. The 15 cm tumor also disappeared.

Currently, the patient's health is stable, he has returned to work and returned to his normal daily life. "Without total body radiation therapy, doctors would only perform stem cell transplantation, the effectiveness would not be as good, and there is a possibility of early relapse," said Dr. Tran Thanh Tung, Head of the Hematology Department.

The patient's treatment cost was about 270 million VND, after deducting health insurance, only 100 million VND was paid. Meanwhile, the cost of a stem cell transplant is currently about 200-400 million VND, due to the long hospital stay and more complications.

The patient received stem cells from her sister, a donor. Photo: Provided by the hospital — Doctor prepares to transfuse stem cells to patient. Photo: *Provided by hospital*

Dr. Huynh Van Man, Head of the Stem Cell Transplant Department, Ho Chi Minh City Blood Transfusion and Hematology Hospital, said that 10 years ago, he expressed to doctors at Cho Ray Hospital his wish that Vietnam could use whole-body radiotherapy to help many patients before stem cell transplants.

"Now the wish has come true, for the first time whole body radiotherapy can be performed by Vietnamese doctors," said Dr. Man. In the past, the Ho Chi Minh City Blood Transfusion and Hematology Hospital has transferred about 5 patients to private hospitals for whole body radiotherapy by foreign doctors, before returning them to the hospital for stem cell transplants.

Dr. Nguyen Tri Thuc, Director of Cho Ray Hospital, assessed that this success has opened up opportunities for cancer patients, because this method has fewer side effects, fewer complications and shorter hospital stays... In the coming time, Cho Ray will coordinate with hematology hospitals to increase the effectiveness of treatment for blood cancer patients, contributing to improving the quality of life for patients.

Le Phuong

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