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Peer program for survivors of blood cancers
Tumeric and green tea for leukemia
New drug for acute leukemia
Rituximab prolongs survival of lymphoma
Avoiding radiation in early Hodgkins
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Advances in radiation for non-Hodgkin’s lymphoma
New chemotherapies coupled with advancements in radiation have made non-Hodgkin’s lymphoma more treatable; this article focuses on what is happening with radiation.
What is non-Hodgkin’s lymphoma?
Otherwise known as NHL, non-Hodgkin’s lymphoma is a tumor of the lymphocytes (blood cells) that is in lymph nodes and organs. Both b-lymphocytes and t-lymphocytes, which combat infections, can be affected—though most NHL is in b-lymphocytes.
Better chemotherapies and better radiation are working together
Typically radiation is standard regimen where high doses of ionizing (damaging) radiation are used to kill cancer cells.
“Now, with current technology, we are treating smaller areas with sophisticated equipment, targeting the lymph nodes. So, there are less side effects to healthy tissue,” says Bernard Eden, MD, medical director of Radiation Oncology at Cancer Treatment Centers of America in Zion, Illinois.
“The technology enables tumors to be targeted more precisely due largely to more advanced imaging. With this form of radiation delivery and better chemotherapies, we have reduced standard radiation dosage needed for treatment. And we are often getting very good results, as lymphoma tends to be radiosensitive,” says Dr. Eden.
How it works
A cone beam computed tomography scanner (CT), which is a CT scanner on the radiation machine, enables image-guided radiotherapy. A CT scan before treatment makes it possible to target the exact location of the tumor. The technology can identify whether the malignancy is shrinking, and adjustments can be made based on the tumor’s size and location.
Additionally, X-ray equipment on the radiation machine allows images to be taken and compared to “simulation” images taken earlier that originally determined the radiation delivery plan. Basically the first images are reproduced with a computer and used to design a radiation plan. A second set of images is taken once you are lined up on the radiation table and compared to the earlier simulation images.
“This technology and process enables us to make sure the path of the beam is traveling to the exact anatomical part of the body where the radiation needs to be delivered,” says Dr. Eden.
Better radiation for an uncommon non-Hodgkin’s lymphoma
Mycosis fungoides is a skin lymphoma that can spread to lymph nodes. This rare condition can be challenging to treat, and is now addressed with total skin electron therapy (TSET), with machinery and technology to treat the entire skin surface but spare other areas of the body.
“We are seeing positive outcomes and better quality of life when we catch and treat mcycosis fungoide early,” says Dr. Eden.
Radioimmunotherapy for non-Hodgkin’s lymphoma
This treatment combines radiotherapy and antibody therapy. It involves the use of a radioactive substance called Yttrium-90 (Y-90) and an antibody called Zevalin (ibritumomab tiuxetan). The antibody is injected into the blood. It attaches to the surface of the cancerous cell, carrying with it the Yttrium-90, which irradiates the cell to destroy it. This therapy is used primarily with b-cell lymphoma.
Initially, this radioimmunotherapy was only for relapsed lymphoma or lymphoma no longer responding to chemo. But now it is becoming standard when the disease responds to chemo.
“As technologies and drugs evolve and become more advanced, we will continue to be able to better treat patients battling cancer. That’s our goal,” says Dr. Eden.
Radiation and lymphoma http://www.lymphomainfo.net/therapy/radiotherapy/index.html
More on radioimmunotherapy
Walking you through transplant and beyond
When you hear you need a bone marrow transplant or stem cell transplant, even if you have a transplant center walking you through what lays ahead, your mind may flood with questions. Blood and Bone Marrow Transplant Information Network is one place to go for more answers, peer support, and other help before and after transplant.
The nonprofit hosts an annual survivorship symposium, webinars, on-line and phone peer support where you are matched with a blood cancer survivor with similar circumstances. There’s a helpline for specific questions; comprehensive web site with easy to understand info about transplant; and patient education books walking you through each step, from pre-transplant through survivorship.
Workshops address issues from dealing with medical complications to depression, changes in sexuality, and challenges for caregivers. The next symposium is April 2013 in Costa Mesa California with sessions spanning chronic graft-versus-host disease, preventing infection and other medical issues, as well as those tied to quality of life.
“At the end of the day we break into networking groups. Some are for patients, some for caregivers. They share experiences, telling what has helped them and reaching out for what they still need help with,” says Susan Stewart, executive director of Blood and Bone Marrow Transplant Network, and a 23-year survivor of acute myeloid leukemia.
These on-line educational programs are for people anywhere in the world who can’t travel. The Sept 2012 webinar focuses on transplant with multiple myeloma. You will learn when a stem cell transplant is appropriate, and if it is, whether to use your own stem cells (autologous transplant) or donor stem cells.
Patient navigation services (helpline)
“The patients, donors and family who call are overwhelmed and have a lot of information to sort through. We spend time explaining; we help them find transplant centers and resources from financial help to respite. We see that they understand the statistics and lead them to additional information; for instance if they have a rare disease we may lead them to experimental transplants,” says Susan.
Sometimes patients get conflicting opinions from different transplant centers, and the person on the other end of the line explains why.
“One center may recommend an adult donor while another may recommend cord blood as a source of transplant. Patients may get different answers on whether to have stem cells manipulated before they are transplanted to remove cells causing graft vs. host disease. We explain the benefits and potential drawbacks to each possibility,” says Susan.
Medical advisors and other practitioners
When the Blood and Bone Marrow Transplant Network can’t answer the question, they go to their medical advisory board—directors of transplant programs throughout the United States. Or if you need supportive services they can’t find, Network facilitators turn to social workers they collaborate with to locate housing, help with medical bills, caregiver support, or whatever you need for your recovery.
Peers are matched by specific diagnosis, treatment, age, or perhaps by if they have young children. Peer match is primarily for patients throughout the United States. But folks tap in for support from around the world using SKYPE to talk “face to face” or e-mail.
The Blood and Bone Marrow Transplant Network supports people with blood cancers, lymphomas, multiple myeloma, and various noncancerous diseases requiring transplant.
To learn more:
Stem cell research moves forward
Leukemia patients who are interested in, and qualify for, a new clinical trial may be able to access a therapy showing promise in an early stage study.
The treatment involves using patients’ own immune cells to destroy cancer. Researchers at the University of Pennsylvania’s Abramson Cancer Center and Translational Medicine created “serial killer” T cells to attack only leukemic cells while sparing healthy ones. The study involved three patients with advanced chronic lymphocytic leukemia (CLL)—whose option otherwise would be bone marrow transplant.
How does this immune therapy work? And what were the results?
Study subjects’ white cells were removed and reprogrammed to attack tumor cells by genetically modifying them to encode an antibody-like protein. A signaling molecule triggers other T cells to multiply, creating more immune cells.
“We saw at least 1,000-fold increase in the number of modified T cells in each patient. Within three weeks, the tumors had been blown away,” says Dr. Carl June, the lead investigator at the University of Pennsylvania.
Another hopeful finding was that the therapy stimulated production of “memory” T cells, which researchers believe may protect against recurrence. So far, the first few study subjects have seen up to a year-long remission.
Abramson Cancer Center will be enrolling patients in the fall of 2011 in another early stage follow up trial, hoping for similar results. (See link below for trial information.) In time research will expand to non-Hodgkins lymphoma, acute lymphocytic leukemia (ALL), and childhood leukemia that’s resistant to conventional treatments.
Meanwhile, there’s similar research happening at the University of Minnesota
It’s in very early stages, but hoped to lead to breakthroughs. The Minnesota study also involves natural killer cells. The big differences with this research: The cells are from – not only embryonic stem cells – but human skin, and can be taken from almost any other location.
“We believe we can take almost any healthy cell in the body and reprogram it to act like a stem cell,” lead investigator, Dr. Dan Kaufman says.
Exactly what is happening in Minnesota? What have been the results?
The experiments have involved taking healthy cells and adding specific genes to reprogram them to act like stem cells. From those cells, natural killer cells are made.
“To date, in cell cultures all the tumors cells die,” says Dr. Kaufman, who is looking at human cells but in animal models.
The objective is to develop therapies to get a remission for a bone marrow transplant. The investigation involves not only leukemia, but pancreatic, breast, prostate, and ovarian cancers.
“While we are years out, our ultimate goal is to someday be able to use these cells in all cancers,” says Dr. Kaufman.
To learn about upcoming University of Pennsylvania trials:
More on the Pennsylvania studies:
More on the University of Minnesota research:
Brand new life is bringing extended life to some blood cancer patients. Cord blood stem cells, taken from newborns’ umbilical cords, are often turning out to be an option for patients in need of a bone marrow transplant who can’t find a match through bone marrow or an adult’s peripheral blood stem cells. New York Blood Center’s National Cord Blood Program, the largest program of its kind, has provided this life-sustaining substance to over 3,500 recipients so far. Globally, over 16,000 cord blood transplants have taken place. This natural gift provides the building blocks of tissue, blood, and the immune system.
Benefit of cord blood cells over bone marrow or peripheral blood stem cells
Cord blood stem cells are available immediately, as they can be frozen and kept in a blood bank indefinitely; the details of each sample are already available, so no further donor testing is required to ensure a match.
“The best outcomes will depend on finding the closest match and on the size of the graft,” says Dr. Andromacchi, Scaradvou, a pediatric oncologist and director of the National Cord Blood Program.
“Caucasians are most likely to find a match, with a 50 percent to 60 percent chance of finding one through a source other than cord blood,” says Dr. Scaradvou, who goes on to report that African Americans have a 20 percent chance of finding a closely matched bone marrow or peripheral donor, and people from mixed ethnicities have a lower chance.
This is where the cord blood banks come in. “We have a very large bank to pool from, and we target ethnic minorities and other groups to broaden the likelihood that a person will find a match,” says Dr. Scaradvou.
Which patients are treatable with blood stem cell transplants? And why do they need these transplants?
Candidates are people with leukemia, lymphoma, and sometimes multiple myeloma and neuroblastoma (cancer originating in the nerve cells, usually in infants and young children).
Those people who become in need of a transplant do so because extremely heavy doses of chemo and/or radiation target all bone marrow cells – both good and bad ones. While the marrow recovers from treatment with cancers not requiring heavy targeting of bone marrow, it does not rebound with the blood diseases. Though some people maintain enough bone marrow that a transplant is not necessary.
How do you determine a good match?
The match is identified by a blood test looking at a protein called human leukocyte antigens (HLA) found on the surface of white blood cells and tissue. Ideally, all six HLA should be a perfect match, though this isn’t absolutely necessary (Proceedings of the National Academy of Sciences. 1992)
Blood stem cell transplants – both peripheral and cord blood – are actually offering thousands of recipients a chance for a cure. Dr. Scaradvou had no statistics because the variables that determine outcome are vast. But on a good note, these harvested cells, received after treatment, are miraculously repopulating bone marrow, providing an endless supply of healthy stem cells, and restoring the immune system.
Also, says Scaradvou, “While it’s not the cancer that blood cord stem cells treat- but rather the effects of treatment – we think it actually helps suppress cancer.”
For more information:
Peer program is olive leaf on a daunting path
Talk about what sounds like bad karma. In 2009 Stacie lost her job in banking, found a lump in her neck, and days later learned she had a fifty percent chance of being alive in a few years. She had advanced stage lymphoma. Right away, she had a thousand questions, some of which were, Will I die? How sick will I be from chemo? Should I participate in a clinical trial? What happens when my Cobra runs out?
And with all that had happened that year, there was the question, What is this, a black cloud over my head? But then another uncanny set of circumstances happened – and the black cloud petered out, replaced with a silver lining. It started with a phone number given to her by a hospital social worker – for the Leukemia & Lymphoma Society‘s Patti Robinson Kaufmann First Connection Program. The program matches newly diagnosed lymphoma and leukemia patients with mentors who’ve been where they are now. Here’s the uncanny part of Stacie’s story:
“I met a lot of people through First Connection, but there was one woman, who little by little I’m finding had so much in common with me. We had the same name, our mom’s had the same name. We lived in different states but she went to school with my cousin. We got diagnosed at the same exact age, and were into so many of the same things.”
Stacie number one and Stacey number two also just clicked.
She’s since made the out of state trek to Ohio, to meet the woman who’d been her phone pal through grueling treatments, answered her questions, or at least known what to say on the rare occasion she didn’t have an answer.
“I’ve met Stacey’s family. I’ve seen her garden like mine, and looked through her pictures,” says Stacie, now in remission. She and her new friend remain close.
“You think all you have to do is get through this, but the challenges keep coming up, and it’s helpful to get someone’s else’s take. Someone who’s been there.
“All along I’ve hung onto the fact that she’s just like me – in an unbelievable number of ways – and that she got through it. Stacey became and continues to be my inspiration.”
The volunteers are people along the same journey, but further down the road. Michele is one of them. On the morning she thought she’d be sending her kids off for their first day of school, she ended up in the emergency room with symptoms that had worsened as she went from doctor to doctor. A stiff neck, a sharp pinch in her hip, rashes on her legs and chest. That day in the ER came the diagnosis: acute myelogenous leukemia (AML), an aggressive disease with limited treatment options.
Two and a half years later, Michele is doing well and loving being a mentor.
“ I want to help with the shock that comes when you hear you have such a serious disease,” she says. “Speaking to these courageous woman is so very rewarding for me.”
The Patti Robinson Kaufman story
Patti Robinson Kaufmann battled lymphoma for more than a decade, and wanted to make others’ fights easier. Just after hearing the words: “20 percent chance for survival” and “stem cell transplant” she threw herself into volunteering for the Leukemia & Lymphoma Society, chairing, along with her father, the Rocky Mountain Chapter’s first Light the Night Walk. She stayed with her work until her last days on earth, helping to grow the event from a small parking lot fundraiser to a celebration drawing more than 4,300 participants and raising about half a million dollars each year. First Connection, which brings together 6,000 newly diagnosed and mentors annually, is named for Patti.
To learn more:
Turmeric and green tea for leukemia
Two naturally occurring compounds: curcumin (found in tumeric) and epigallocatechin-3-gallate (green tea extract) have been shown effective against chronic lymphocytic leukemia (CLL) (reported in Clinical Cancer Research and Pub Med)
In the lab, curcumin inhibited metastasis and invasion of, as well as blood flow to, tumor cells. The compound ingredient in the spice works much like chemotherapy, resulting in tumor cell death. Adding green tea extract produced more effective outcomes, but the two compounds are not to be taken at the same time.
There have actually been multiple studies dating back several years attesting to the power of “the golden spice” and even more attesting to green tea’s potential to treat the disease. Mayo clinic researchers suggested in 2005 that green tea halts leukemia. And researchers at the Harvard School of Public Health claimed three years later that people aged 16 to 29 who drank at least five and a half cups of green tea daily had less than half the risk of develoing leukemia as those who consumed little of the drink.
More clinical trials are currently underway to learn more about best dosage and how the ingredients work.
New drug for acute leukemia
Cloretazine (OnriginTM) has brought great promise to some relapsed patients with acute myeloid leukemia (AML). About 30% of them in a recent National Foundation Cancer Research (NFCR) study had a complete response – their signs of cancer disappeared.
Why the drug works for which patients is still a mystery – one that researchers are working to unravel so they can predict the most appropriate candidate for cloretazine.
But this is what is known to date: the drug works best in elderly people and in tumors with low levels of a protein called AGT. AGT levels vary greatly in individual patients. So the focus of the research now is developing a reliable method of measuring the substance to identify who cloretazine is best for.
Researchers have begun working to determine how often the cancer “turns off” the AGT gene, which makes the drug all the more effective. Meanwhile the AGT measurement test is already being used on human tumors, and will probably be available in clinics soon, predicts NFCR expects.
A new targeted therapy may bring promise to many people with lymphoma who until now had only chemo as treatment. In a recent trial of over 300 patients, 91% who were given Rituximab survived 3 years; compared to 86% given chemotherapy only.At three years, 68% of the Rituximab group had no more progression compared to 33% of those who had only chemotherapy. Adverse side effects were minimal, though there were some.
Who was studied?
Patients with stage III and IV non-Hodgkin lymphoma, older than 18 years, who had no prior therapy. Non-Hodgkin patients included small lymphocytic, follicular small cleaved, and follicular mixed small and large cell lymphomas.
How was the study done?
Four weeks after the last combination chemotherapy using cyclophosphamide, vincristine, and prednisone, half the patients who were responding to treatment or whose cancer was not advancing received Rituximab. They took the drug once per week, for 4 weeks, every 6 months for four courses. The other half had no further treatment.
Why targeted drugs like Rituximab look promising:
The newer drugs often have less serious side effects, as they target cancerous cells, killing fewer healthy ones, and may work where chemotherapy doesn’t. Rituximab, specifically, works by reducing inflammation. It’s among a few therapies that have made a slowly growing list – new, targeted agents advancing in the fight against lymphoma.
Finding clinical trials:
Young patients with early Hodgkins lymphoma may be able to bypass radiation and still get the best outcomes according to a Harvard study. (Journal of Clinical Oncology, Feb 16, 2010)
The alternative is a chemotherapy regimen, which involves six cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine.
All patients of the Harvard study went into complete remission from chemotherapy alone; 92% were in complete remission 60 months later. Everyone of them is alive today, though the relapsed patients later received radiation, chemotherapy, and autologous stem-cell transplants.
Another study done by German researchers also suggests less is better. Researchers found that two cycles of chemotherapy followed by small amounts of radiation are as effective and less toxic than more intensive regimens in stage I or II Hodgkins lymphoma. (New England Journal of Medicine, Aug 12, 2010).
As more patients live longer, even beat the disease, researchers continue to work on the balancing act to determine how much treatment is just enough without causing long-term negative effects. The general consensus, as the formula continues to be studied, is that cutting back on radiation would likely decrease second malignancies.
Known infamously to most as a deadly poison, arsenic has proven a powerful attacker against acute promyelocytic leukemia (APL). Actually, arsenic trioxide has been known for years to be highly effective against relapsed APL.
But what’ new, according to a Wake Forest Baptist Medical Center study, is that patients live longer if they are treated early, rather than wait for a recurrence. (Blood Nov 11, 2011).
“For this study, we used arsenic as an early consolidation therapy after the initial standard treatment to essentially, as one of our first patients described, ‘seal the deal’ the first time around,” said Dr. Bayard Powell, a lead study investigator at Wake Forest Baptist.
After three years, event-free survival was 80 percent in the arsenic group versus 63 percent in the non-arsenic group; there have been no relapses to date. The results were as promising in the patients with high white blood cell counts and other risk factors, which is encouraging because people with high white cells often have not done well.
APL accounts for about 10 to 15 percent of acute myeloid leukemia cases and is most common in young adults. Current treatment involves a combination of all-trans retinoic acid (ATRA) plus chemotherapy followed by additional “consolidation” chemotherapy, followed by further ATRA. Sometimes there is further maintenance chemotherapy.
What did the study entail?
All participants got standard treatment. One group also received two 25-day courses of arsenic trioxide.
The patients in the investigational group received arsenic trioxide, five days a week, for five weeks, with a two-week break between courses.
“We think people who received the arsenic trioxide after initial standard treatment are likely cured,” Powell reported to ScienceDaily.