Фоликулярен Неходжкинов лимфом

Много интересно предаване за нетолерантността към глютена http://play.novatv.bg/play/313160/?autostart=true
Моят съпруг страда от стомашни проблеми още от преди диагнозата. Сега е почти изцяло на диета без глютен, но и без млечния протеин касеин и без лактоза.

Капсули от рибено масло изглежда, че подпомагат имунитета срещу слънчевите лъчи, според английски изследователи. Има добре документирана връзка между неходжкин лимфома и меланома или други видове рак на кожата. Според допълнителни доклади тези други видове изглежда са по-агресивни от обичайно при пациенти, които са с диагноза неходжкин. Може ли рибеното масло, с високите си дози витамин А, Д и омега-3 да служи като защита?
Например в предишен пост споменах, че ниски нива на витамин Д се свързват с развитето на неходжкин и с по-лоша прогноза. Това, което не знаем е, дали има в действителност причинно-следствена връзка между тях. Много изследвания обаче подсказват това. Има вече няколко изследвания, които показват, че колкото по-далече от екватора живеем, толкова по-голям е рискът от развитие на неходжкин, тъй като има по-малко слънчева светлина и от там тялото произвежда по-малко витамин Д.
http://www.telegraph.co.uk/health/healthnews/9892490/Oily-fish-c … -skin-cancer.html

Ето и една от най-добрите статии за фоликулярен, които съм чела напоследък : http://www.medscape.com/viewarticle/776324?src=stfb
http://www.medscape.com/viewarticle/776324?src=stfb

Резултати от клинично изследване: лечението включва lenolidomide (линолидомайд) и мабтера. Провежда се на 28 дневни цикли в продължение на 6 месеца. На първия ден се влива мабтера (стандартна доза) и в продължение на 21 дена се приема хапчето lenolidomide 20 милиграма. При фоликулярен лимфом 45 от 46 пациента достигат ремисия, като 87% от тях имат пълна ремисия, като под наблюдение в продължение на вече две години, 81% продължават да са в ремисия.
Лечението НЕ включва химиотерапия. Ленолидомайд дейсва на клетъчно ниво като влияе на микросредата по такъв начин, че имунните клетки започват да разпознават раковите и ги унищожават. Знаем, че причината да се развие фоликулярен, е че имунните клетки не разпознават мутиралите като чужди и затова не ги унищожват. Но ето че линолидомайд в комбинация с мабтера позволява това разпознаване да се случи.
В интервюто се спомена, че това е серия от международни изследвания. В тази връзка, ако някой се интересува, такова клинично изследване се провежда в Германия, в Австралия и в САЩ.
Докторът на Кен му предложи да участва преди година и нещо. Провеждаше се в Чикагския университет, но Кен предпочете да участва в изследване на местно ниво. Но си спомням, че докторът беше доста оптимистично настроен към линолидомайд, и ето че е имало защо.

http://www.-spam159-/dieti-i-hranene/ot-kde-da-si-nabavim-vitamin-d/#.UbjUmGXXfN4
Витамин Д

Имунноподтискащите лекарства, които се дават на пациентите с трансплантация на органи повишават риска от лимфом. Най-често срещаният вид лимфом при децата е Burkett's лимфом при по-малки деца и Hodgkin's (на Ходжкин) при тинейджъри и от двадесет до 30+ годишни. И двата вида са с добра прогноза в по-голяма част от случаите и са личими. По-рядко срещани при деца са Т-клетъчните лимфоми, но и това се случва. При тези случаи често се намира CD-30 антиген на повърхността на много от лимфомните клетки. В тези случаи антитялото с лекарство, което се нарича Adcetris (или официално название SGN-35, brentuixmab vedotin) е едно от новите възможни ефективни лечения.
http://abclocal.go.com/kgo/story?section=news%2Flocal%2Fpeninsula&id=9138416

http://www.sciencedaily.com/releases/2013/06/130613124309.htm
Mишка на седмицата  - Изследователи от Маунт Синай колеж по медицина са успели да създадат подобни на човешките кръвни стволови клетки в мишки- точно каквито ние събираме от нас за трансплантация на стволови клетки (или по друг начин казано на костен мозък). Това поставя основите на бъдещо развитие на стволови клетки за заместване на клетки от всякакъв тип, както и потенциално ще подпомогне в скоро време и пацинти, които имат ниски бели и червени кръвни телца или ниски тромбоцити.

Zevalin (радиоимуннотерапия) и BEAM (химиотерапия) е една от най-успещните комбинции и подобрява прогнозата на пациентите не само при индолентен (или бавнорастящ) лимфом, но и при рецидив при пациенти с Неходжкинов индолентен и агресивен, както и при по-възрастни пациенти. Когато пациентите преминават през тази комбинирана терапия преди трансплантация на костен мозък, животът без прогресия (рецидив) и въобще продължителността на живота като цяло се удължава. 100% от пациентите преминали Z-BEAM са живи две години след лечението.

News from the Society of Nuclear Medicine and Molecular Imaging 2013 Annual Meeting

"Radioimmunotherapy Improves Lymphoma Survival"

Jim Kling for Medscape

Jun 14, 2013

In patients with refractory or relapsed aggressive lymphoma, immunoradiation (RIT) combined with high-dose chemotherapy is associated with better progression-free and overall survival than chemotherapy alone when used in advance of autologous stem cell transplantation.

The BEAM chemotherapy consists of BCNU, Etoposide, Ara-C (cytaribine), and melphalan.

"We started adding immunoradiation to BEAM about 9 years ago," said Tzila Zwas, MD, professor of nuclear medicine at Tel-Aviv University in Israel. "It was the hematologists' idea, because BEAM alone extended patients' lives by a few months only. The prognosis was very grave."

When Y-90 ibritumomab tiuxetan (Zevalin) was added to high-dose chemotherapy, "it was so successful — extending lives by over 2 years — we decided to conduct a multicenter trial," she explained.

Dr. Zwas presented the results here at the Society of Nuclear Medicine and Molecular Imaging 2013 Annual Meeting.

In the trial, the 22 patients randomized to Z-BEAM were treated with BEAM plus ibritumomab tiuxetan 0.4 mCi/kg 14 days before transplantation. The 21 patients in the control group were treated with BEAM alone. Patients in the 2 groups had similar disease characteristics.

All subjects responded to second-line therapy, but 17 had positive PET/CT scans prior to transplantation. The researchers analyzed progression-free survival and 2-year survival. Neutrophil and platelet recovery occurred in a median of 10 days in the Z-BEAM group and 13 days in the control group.

There was no difference in treatment-related deaths. Overall 2-year progression-free survival was 53% (95% confidence interval, 39% - 78%). There was more 2-year progression-free survival in the Z-BEAM group than in the control group (64% vs 43%; P = .2).

Poor prognostic factors for overall survival were:

* advanced age (hazard ratio

---

, 8.3; P = .001)
* high-risk disease (HR, 2.8; P = .04)
* positive pre-transplant PET/CT (HR, 2.4; P = .07).

Progression-free survival in patients with 1 or 2 of these factors was better in the Z-BEAM group than in the control group (76% vs 38%), as was 2-year overall survival (100% vs 63%).

The researchers also found that receiving BEAM alone [without Zevalin RIT] was a prognosis factor for poor overall survival (HR, 2.8; P = .03).

The Z-BEAM approach improved overall and progression-free survival, "which is critical in hematology," said Dr. Zwas. The researchers also found positive effects in elderly patients. "This is very good news because we are dealing mostly with elderly patients. Refractory or relapsed aggressive lymphoma is not as common in the young age group. If elderly patients can achieve quality of life with low toxicity, it's unbelievably beneficial to them," she added.

This study was well designed. Although the trends did not reach statistical significance, they likely would have with a larger patient population, according to Norman LaFrance, MD, chief medical officer and vice president of medical and regulatory affairs at Jubilant DraxImage in Kirkland, Quebec, Canada.
"In the poor-prognosis patients, when they did a subanalysis, progression-free survival just missed significance — that's one of the reasons I believe that higher numbers of patients would have made a difference. If they conducted another trial with triple the enrolment, my bet is that the trends they're reporting would reach significance," Dr. LaFrance told Medscape Medical News.

Dr. LaFrance said he hopes to see radioimmunotherapy combined with chemotherapy in earlier stages of disease and in other indications. "It's an evolution that hasn't occurred quickly enough, but I think it will," he explained. Medical oncologists are not trained to deal with radiation therapy, and there could be issues of reimbursement. "It's complicated, it's multifactorial, but I think it's turning the corner that people think combining radioimmunotherapy with chemotherapy is the right thing to do."

Ето и новини за лимфом на Ходжкин от Европейския конгрес на хематолозите, който се провежда от няколко дни:Каква е най-добрата химиотерапия с цел да се намали риска от рецидив и за най-добра преживяемост? Шест цикъла от увеличена доза (или с други думи най-високата доза, която специфичен пациент може да толерира, но безопасно) BEACOPP бие по много показатели ABVD. Германски изследователи анализатори казват, 4е BACOPP има две трети  шанс да е много по-добра терапия oт ABVD- даже от много повечето цикъла на ABVD. Повече не означава по-добре, особено ако пет скенера е позитивен след два цикъла на ABVD.
Ако даден пациент е трети или четвърти стадий ХЛ и/или има фактори като тумор или тумори по-големи от 5 см., висока температура и необяснима загуба на тегло, или проява на болеста извън лимфните възли (в органи като черен дроб, бели дробове, или кости), BEACOPP изглежда доставя по-добри резултати, по-малко рецидиви и по-дълга цялостна преживяемост (удължава живота), и доколкото може да се заключи на този етап, по-малък риск от развитие на второстепенни ракови заболявания (ракови заболявания в следствие на химио- или радиотерапии в по-късен етап на живота) в сравнение с ABVD.
Прочетете тук:

FIRST-LINE TREATMENT OF ADVANCED STAGE HODGKIN LYMPHOMA – FINAL RESULTS OF A SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS

Authors - Michaela Rancea 1,*, Nicole Skoetz 2, Sven Trelle 3, Heinz Haverkamp 4, Andreas Engert 5, Peter Borchmann

Background: Hodgkin lymphoma (HL) in advanced stages can nowadays be cured with different combined-modality approaches, but the debate whether BEACOPPescalated (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone) or ABVD (doxorubicin, bleomycin, vincristine, dacarbazine) is superior is still ongoing. ABVD results in a lower progression-free survival, but might be better tolerable than BEACOPPescalated. With regard to the most important patient-related outcome overall survival (OS) no high-level evidence supporting one or the other strategy has been generated up to date.

Aims: To assess the efficacy (OS, freedom from treatment failure, FFTF) and safety (secondary neoplasia) of different first-line treatment strategies over standard ABVD and to provide a hierarchy of the regimens for patients with advanced stage HL.

Methods: We developed sensitive search strategies for CENTRAL, MEDLINE, and conference proceedings from 01.1980 to 09.2012, additionally, we obtained missing data from investigators. Two authors independently screened search results, extracted data, and assessed quality of trials. We pooled data using network meta-analysis and combined direct with indirect comparisons with Bayesian random-effects models. Results were reported relative to ABVD, indicating superiority of ABVD if hazard ratio (HR) > 1.

Results: The search resulted in 2,229 relevant references, of which 74 publications with 14 randomised controlled trials evaluating eleven different regimens were included. Overall, we judged the methodological quality of trials as high.

Six cycles BEACOPPescalated (HR = 0.38, 95% credible intervals (CrI) 0.20 to 0.75) and eight cycles BEACOPP-14 (HR = 0.43, 95% CrI 0.22 to 0.86) were associated with the lowest risk of mortality and showed a 98% probability to be the best treatment regimens for patients with advanced HL (see forest plot of overall survival). Additional standard meta-regression estimated an 89% five-year survival rate for ABVD, resulting in a five-year survival benefit of 7% for both regimens: six cycles BEACOPPescalated (95% CrI 3% to 10%) and eight cycles BEACOPP-14 (95% CrI 2% to 9%) as compared to ABVD. These results were confirmed by the reconstructed digitised individual patient analysis, that included 10,042 patients and 1,189 deaths over 47,033 patient-years of follow-up. OS was increased by 10% (95% CI 3% to 15%) at five years with six cycles BEACOPPescalated compared to ABVD.

Freedom from treatment failure [FFTF, i.e., relapse] showed similar results: six cycles BEACOPP (dose escalated) have a 66% probability to be the best treatment regimen (HR = 0.37, 95% confidence interval (CI) 0.12 to 1.08) and eight cycles BEACOPP-14 have a probability of 15% to be the best (HR = 0.51, 95%CI 0.16 to 1.48). Overall, the assessment of between-trial heterogeneity was low: τ2=0.01 for OS and τ2=0.05 for FFTF.

Data for secondary malignancies was provided by twelve trials with 50,736 patient-years of follow-up. A total amount of 327 secondary malignancies and 109 leukaemias occurred. The low number of included trials led to wide overlapping credible intervals which additionally included the null effect. The low number of events made quantification of the risks associated with each regimen impossible.

Summary / Conclusion: This network analysis of different first-line treatment strategies for patients with advanced stage HL has shown a relevant benefit for FFTF [freedom from treatment failure, i.e., relapse] and OS [overall survival] with six cycles BEACOPP [dose escalated] and eight cycles BEACOPP-14 as compared to standard ABVD.

The Overall Survival difference o ABVD is not only HIGHLY SIGNIFICANT but also relevant for patients with advanced stage HL.

Study author affiliations:

1Department I of Internal Medicine, University Hospital of Cologne, Cochrane Haematological Malignancies Group, 2Cochrane Haematological Malignancies Group, Department I of Internal Medicine, Univeristy Hospital of Cologne, Cologne, Germany, 3CTU, Institute of Social and Preventive Medicine, Bern, Switzerland, 4German Hodgkin Study Group, 5Department I of Internal Medicine, University Hospital of Cologne, 6German Hodgkin Study Group, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany

Лимфомът няма ракови стволови клетки в същия смисъл, в който солидните тумори имат. Стволовите ракови клетки на солидните тумори са виновниците за появата на метастази- или разпространяването на раковото заболяване от една част на тялото към друга. Лимфомните клетки пътуват в лимфната система, което начинът им на разпространение, но това не е толкова унищожително, колкото са истинските метастази по принцип.
http://www.telegraph.co.uk/health/healthnews/10123547/Scientists … ncers-spread.html

http://www.cnn.com/2013/06/20/health/time-leukemia-drug/index.html?hpt=hp_t2
Tова е само едно от леченията, които са на хоризонта и скоро ще са одобрени за употреба. Статията говори специфично за употребата на ibrutinib при ССL (вид, който спада и в категорията левкимия, и в категорията лимфом), но той се тества и при фоликулярен и други видове (споменала съм за него в по-горни постове). Той е хапче и има за таргет протеина Bruton's tyrosine kinase (BTK). Не е химио и има вероятност да измести нуждата от химио в бъдеще. Има и други подобни лечения в клинични изследвания и то много от тях, които постоянно бълват . Това е добре и дава много надежда!

Невероятно- ваксина против рак: http://www.nbcphiladelphia.com/news/health/Local-Researcher-Unlo … er-209113511.html
Вземат се билиони Т-клетки от пациенти с левкемия. В тях се вкарва деактивиран ХИВ вирус, който промен ДНК-то им. Променените клетки са програмирани вече да разпознават и убиват раковите. Вкарват се обратно в тялото на пациента. За първи път тази терапия се прилага през 2010 при 12 пациента, от които девет са с пълна или частияна ремисия след лечението. Доктор Карл Джун получава наградата на Филаделфия за това си откритие. Той казва, че тези клетки "серийни убийци" са спящи в организма, но се активират, ако ракът се появи отново и го унищожават. Ето защо може да се ваксинира едно дете и ефектът остава. Джун казва, че следващата стъпка е да се използва генетична терапия за борба с други видове рак. Клинични изследвания започват това лято за пациенти с рак на панкреаса.

Здравейте! Намесвам се в тази тема просто защото не знам къде да пиша! Изчела съм какво ли не вече в интернет, за какви ли не болести. Просто искам да попитам при никакви отклонения в пълната кръвна картина възможно ли е да има някакво сериозно заболяване? От около месец имам увеличен лимфен възел под челюстта и 2ма лични лекари ми казват, че нищо ми нямало и 99% процента било от някой зъб, който правил гранулом или нещо такова. Не съм отишла да си правя снимка все още на зъбите и много ме  е страх, ако се окаже че не е от зъбите да не е някой рак Моля ви за вашето мнение! Хубава вечер :

Мисля, че може би е най-добре да се доверите на лекарите. Подут лимфен възел може да се появи от всякаква инфекция в устната кухина, от настинка до зъб. Понякога се уголемява и спада, друг път спада, но не напълно, в някои случаи не спада. Ако докторите не са алрмирани и няма други симптоми като висока температура (постоянна), внезапна загуба на тегло, обилни нощни изпотявания (при които се налага смяна на спалното белъо) и ред други, мисля че не е обезспокоително (симптомите, които изброих се свързват с лимфом, но може да имат и други причини, като менопауза при изпотяването и други).

Благодаря за бързия отговор, малко се успокоих защото нито имам температура, нито се изпотявам вечер, Ама това топче не спада и постоянно ръката ми е там, да проверявам дали е спаднало. От 4-5 дни усещам все едно сливицата ми е уголимена, преглъщам по трудно и като я пипна и тя има някакво топче, а гърло не ме боли наболяваме примерно сутрин като стана за малко... момичета побърквам се май възможно ли е тоя лимфен възел да я притиска и за това така да се получава или може да е някой рак на гърлото четох някъде че лимфен възел спадал много бавно и можело даже да се проточи и година, аз до тогава ще полудея сигурно от да го мисля

Ето и копиран коментарът на един от приятелите ми по фейсбук с това заболяване. Когато имам повече време ще преведа основните неща от срещата му с един от известните специалисти тук по отношение на новите лечения за фоликулярен лимфом.

Hey everyone. Had a great appointment with Oliver Press today (and the Fellow who was assisting him). Each doctor spent about 40 minutes with me, so I was in there a while. I'm sorry if this post gets a little long!

Oliver Press was extremely nice, and had a big sense of humor. I laughed out loud at me on several different occasions, which I appreciated. He also referred to our numerous emails over the last few years and said he was glad to finally get to meet me in person. That was great.

As far as me and my health are concerned, I am in perfect health as far as we know. He doesn't need to see me for 6 months, and we will do labs only then. He said no scan for at least another year, and it will be a CT only, when we do it. He said he wants to really get to know me and my particular situation better first, and actually asked me what my position was on all the latest research on scanning.

I'll go through this looking at my notes, so bear with me:

I had a whole list of questions of course, and tried not to occupy too much of his time, meaning I had to go pretty quick. First off, he expressed his regrets about Bexxar and said both he and Mark Kaminski were "quite upset about it," but there was nothing they could do at this point. He did say that he felt Zevalin was an equally good drug however.

His new alpha-emitter RIT research is still very early, and won't reach human trials for a few years. Alpha emitting radiation packs a much bigger punch (a brighter flash basically) than beta emitters like Bexxar or Zevalin. This means its kill factor is greater, but it damages less surrounding cells because its "reach" is not as far. He said this new version of RIT will certainly surpass what we have available today with Zevalin or Bexxar.

We talked about GA-101, (obinutuzumab ) now referred to as "Gazyva," as well. He said this new mab is made by the same company who makes Rituximab, and is intended to ultimately replace it. He said it is interesting, but this new drug was "far better" than Rituxan in the test tube, "far better" in mouse studies, but only "marginally different" with human subjects so far. He said he has no explanation for this, but still believes that once the data matures over time we will hopefully see a noticeable improvement over Rituxan. He said initially, he was one of the major proponents of GA-101, and ran it in trials (and still does). Only time will tell however, and the infusion reactions are certainly higher than you get with Rituxan.

He was encouraging about Ibrutinib as well, and said many trials are in process. I think in general, his response to the btk-inhibitor group of drugs was good. I also asked about ipi-145, though he was not familiar with that one. I asked about Dr. Maloney's engineered t-cell theraphy, and Press said it was "extremely promising," but still very early and quite dangerous, only used for those patients who have extended all other options.

I asked him as well what his general stance was on vaccines, knowing some doctors have biases one way or the other. He said he had a great deal of respect for Levy and Kwak and all of the work done from that group, but that nothing had really proven to be all that effective yet. He was very enthusiastic about the CpG-like in-situ vaccination immune work being done by Josh Brody at Mt. Sanai, though it was "very early yet."

Perhaps one of the most significant things I heard today was regarding transplants. Dr. Press told me that he has only referred 1 out of 10 follicular lymphoma patients for an Allo transplant. He said 9 out of 10 of us will never, ever need it. He reiterated the dangers involved, and that the mortality rate was 15 to 25% by the second year, "depending on which study you want to refer to." He said, "Allo transplants can and do cure the disease, but they can also be quite dangerous, only used when all other therapies have been exhausted." He said he refers patients when necessary and appropriate. For someone like me, though he can't predict the future, will most likely never be something I will have to face. He did acknowledge the paradox that exists regarding transplants: the younger you are and the fewer treatments you have had, the better your chances, but you don't do these until you are far down the line. Total dilemma. Nobody will send anyone for an allo transplant who is young and in good health, even if it might certainly cure them.

I told him one of my goals was to out-last the life of chemo, meaning I never wanted to have to do it, and hoped it would no longer be used in the future. He said this is certainly being stated by many, but the issue is knowing WHEN it will actually be phased out for good. As of now, it is absolutely necessary for many.

We talked about the new chemo-loaded antibodies, that act much like RIT, though instead of radiation, are chemo-loaded antibodies. He said so far this novel therapy (in trials at Fred Hutch as well) is very promising, but does come with side effects like neutropenia and others.

We talked about my concerns regarding relapse, and not getting caught off-guard if we elected not to scan for a year or longer. He said, given the way my disease presented itself—very low tumor burden, small nodes in neck and groin, no symptoms, etc., it was unlikely (not guaranteed) that any relapse would ever occur in my abdomen or some other unexpected spot. He said that patients like me will usually, if and when they relapse, relapse in the same body regions (which is very good for me apparently), and it is usually something either I will notice, or he will on a physical exam.

Regarding my choice in early 2012 to do early Rituxan: he said that while there was no long-term data (yet) to support that choice, he recognizes how it might pay off, and why I might have chosen to do that over watch and wait. He said that for someone like me (again, and my disease characteristics), who had anxiety about watch and wait, and had no negative issues or reactions with the drug, Rituxan alone was a very reasonable (I hate that word) choice. And we don't know how well or long it might work for each individual. He said we would expect since I did have such a good response, it might be very durable. And he supported the RESORT trial notion of re-treatment when necessary, particularly since it was so easy for me.

I told him I did not believe in watch and wait. He (and his Fellow) reminded me (of which I am quite familiar) with the data, historical position, etc. on this. I told him that it seemed to me (still) that the reason Overall Survival shows no difference between w&w and early Rituxan is because patients from both "arms" are still alive, regardless if they were treated or not, given the history of indolent lymphomas. Not enough time has passed to KNOW. He agreed that was definitely part of it. The other thing we have to remember here is, my age. MOST of the patients these guys see are over 60. They are easier. With younger people like me they have to be more cautious what they say and predict.

The best part of the day was when he asked me, "how did you ultimately decide to go forward with the Rituximab?" I said it came down to basic math and common sense for me. I told him, "I figured the less lymphoma cells I had in my system, the less my chances would be for one of those cells to transform. If there are 10 lymphoma cells, wouldn't I be 9 times more likely for one to transform than if I had just 1 lymphoma cell?" Reduce the number and reduce your chances. He chuckled, and said, "that sounds like smart thinking to me."