Lenalidomide has shown promising activity against various types of lymphoma in clinical trials. It achieved objective response rates of 44% in relapsed/refractory peripheral T-cell lymphoma and 53% in mantle cell lymphoma. Bortezomib also achieved durable responses as a single agent in relapsed/refractory mantle cell lymphoma. The addition of rituximab to standard chemotherapy such as CHOP has improved outcomes in diseases like DLBCL and increased 5-year survival rates. Combining epratuzumab with rituximab has also shown high response rates in recurrent indolent lymphomas. Radioimmunotherapy with 90Y-ibritumomab tiuxetan following R-
This is NHL clinical update on 57th ASH Annual Meeting and Exposition (December 5-8, 2015).
It includes only clinical aspects include both chemotherapy and antibody therapy.
Myron Czuczman, M.D., Professor Chief, Lymphoma/Myeloma Service, Dept. of Medicine Head, Lymphoma Translational Research Laboratory Dept. of Immunology Roswell Park Cancer Center
Evolving Management of Follicular Lymphoma
Presented at New Frontiers in the Management of Solid and Liquid Tumors hosted by the John Theurer Cancer Center at Hackensack University Medical Center. jtcancercenter.org/CME
This is NHL clinical update on 57th ASH Annual Meeting and Exposition (December 5-8, 2015).
It includes only clinical aspects include both chemotherapy and antibody therapy.
Myron Czuczman, M.D., Professor Chief, Lymphoma/Myeloma Service, Dept. of Medicine Head, Lymphoma Translational Research Laboratory Dept. of Immunology Roswell Park Cancer Center
Evolving Management of Follicular Lymphoma
Presented at New Frontiers in the Management of Solid and Liquid Tumors hosted by the John Theurer Cancer Center at Hackensack University Medical Center. jtcancercenter.org/CME
Audio and slides for this presentation are available on YouTube: http://youtu.be/rAgnoymx0DQ
Dr. Ann LaCasce talks about the various treatments for lymphoma, including chemotherapy and radiation therapy methods, as well as the role of clinical trials. This presentation was first given at a lymphoma workshop presented by the Lymphoma Research Foundation (www.lymphoma.org).
Acquired Resistance to Targeted Therapy in EGFR and ALK-Positive Lung Cancer:...H. Jack West
This is a presentation I did for a meeting on new general management of acquired resistance in 2014, including the concept of local therapy for limited progression, and new treatment approaches and new agents for this setting. It features discussion of several of the most important trials.
Audio and slides for this presentation are available on YouTube: http://youtu.be/pkB_mfPtjrA
Andrea K. Ng, MD, of Dana-Farber/Brigham and Women's Cancer Center Department of Radiation Oncology, gives an overview of the different types of radiation therapy, the side effects, and how it is used in the treatment of lymphoma. This presentation was given at the 2013 Lymphoma Research Foundation North American Forum on Sept. 29, 2013. http://www.dana-farber.org | http://www.lymphoma.org
Audio and slides for this presentation are available on YouTube: http://youtu.be/Q_wdfcJO3XE
Ann LaCasce, MD, MMSc, of Dana-Farber/Brigham and Women's Cancer Center Adult Lymphoma Program, talks about new clinical trials and treatments available for lymphoma patients. This presentation was originally given at the Lymphoma Research Foundation North American Forum on Sept. 28, 2013. http://www.dana-farber.org | http://www.lymphoma.org
Audio and slides for this presentation are available on YouTube: http://youtu.be/rAgnoymx0DQ
Dr. Ann LaCasce talks about the various treatments for lymphoma, including chemotherapy and radiation therapy methods, as well as the role of clinical trials. This presentation was first given at a lymphoma workshop presented by the Lymphoma Research Foundation (www.lymphoma.org).
Acquired Resistance to Targeted Therapy in EGFR and ALK-Positive Lung Cancer:...H. Jack West
This is a presentation I did for a meeting on new general management of acquired resistance in 2014, including the concept of local therapy for limited progression, and new treatment approaches and new agents for this setting. It features discussion of several of the most important trials.
Audio and slides for this presentation are available on YouTube: http://youtu.be/pkB_mfPtjrA
Andrea K. Ng, MD, of Dana-Farber/Brigham and Women's Cancer Center Department of Radiation Oncology, gives an overview of the different types of radiation therapy, the side effects, and how it is used in the treatment of lymphoma. This presentation was given at the 2013 Lymphoma Research Foundation North American Forum on Sept. 29, 2013. http://www.dana-farber.org | http://www.lymphoma.org
Audio and slides for this presentation are available on YouTube: http://youtu.be/Q_wdfcJO3XE
Ann LaCasce, MD, MMSc, of Dana-Farber/Brigham and Women's Cancer Center Adult Lymphoma Program, talks about new clinical trials and treatments available for lymphoma patients. This presentation was originally given at the Lymphoma Research Foundation North American Forum on Sept. 28, 2013. http://www.dana-farber.org | http://www.lymphoma.org
What is Lymphoma?
Malignant lymphoma is a term given to tumors of the lymphoid system and specifically of lymphocytes and their precursor cells
i.e.
Cancer of the lymphatic system.
Many lymphomas are known to be due to specific genetic mutations.
Austin Journal of Clinical Cardiology is an open access, peer reviewed, scholarly journal dedicated to publish articles in all areas of cardiology and angiology. The aim of the journal is to provide a forum for cardiologists, researchers, physicians, and other health professionals to find most recent advances in the areas of cardiology and cardiovascular diseases.
Austin Journal of Clinical Cardiology accepts original research articles, review articles, case reports, clinical images and rapid communication on all the aspects of cardiology and circulatory system.
Austin Journal of Clinical Cardiology strongly supports the scientific upgradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed journals under one roof thereby promoting knowledge sharing, mutual promotion of multidisciplinary science.
Austin Journal of Clinical Cardiology is an open access, peer reviewed, scholarly journal dedicated to publish articles in all areas of cardiology and angiology
The Role of Immunity in Chemotherapy-Resistant Patient with Pembrolizumab: A ...JohnJulie1
Approaches are limited for treating advanced Non-Small-Cell Lung Cancer (NSCLC) with multidrug resistance but without ALK and EGFR mutations. Pembrolizumab (KEYTRUDA) brings on unprecedented clinical benefit in various cancer types...
The Role of Immunity in Chemotherapy-Resistant Patient with Pembrolizumab: A ...NainaAnon
Approaches are limited for treating advanced Non-Small-Cell Lung Cancer (NSCLC) with multidrug resistance but without ALK and EGFR mutations. Pembrolizumab (KEYTRUDA) brings on unprecedented clinical benefit in various cancer types..
The Role of Immunity in Chemotherapy-Resistant Patient with Pembrolizumab: A ...EditorSara
Approaches are limited for treating advanced Non-Small-Cell Lung Cancer (NSCLC) with multidrug resistance but without ALK and EGFR mutations. Pembrolizumab (KEYTRUDA) brings on unprecedented clinical benefit in various cancer types..
The Role of Immunity in Chemotherapy-Resistant Patient with Pembrolizumab: A ...daranisaha
Approaches are limited for treating advanced Non-Small-Cell Lung Cancer (NSCLC) with multidrug resistance but without ALK and EGFR mutations. Pembrolizumab (KEYTRUDA)
Here we present a case report of a NSCLC patient had not benefited from Pembrolizumab therapy following chemotherapy. We reviewed the treatment and clinical examination profiles, especially the Immunological indicators. In the ending stage, the patient appeared
pneumonia, respiratory failure, septicemia, gastrointestinal hemorrhage, and hypoproteinemia.
The percentage of CD4+ and CD8+ T cell in peripheral blood were decreased companion the
expression of PD-1. However, the percentage of MDSC (myeloid-derived suppressor cells) was
increased continuously. We also detected the expression of PD-1 on T cell in pleural effusion
that was under the average value of 24 cases and in the tumor site that was the same with the
pleural effusion. Besides the detected CD8+ T lymphocyte infiltration was very low. The overall
survival was 6 mouths.
The Role of Immunity in Chemotherapy-Resistant Patient with Pembrolizumab: A ...ClinicsofOncology
Approaches are limited for treating advanced Non-Small-Cell Lung Cancer (NSCLC) with multidrug resistance but without ALK and EGFR mutations. Pembrolizumab (KEYTRUDA) brings on unprecedented clinical benefit in various cancer types
The Role of Immunity in Chemotherapy-Resistant Patient with Pembrolizumab: A ...semualkaira
Approaches are limited for treating advanced Non-Small-Cell Lung Cancer (NSCLC) with multidrug resistance but without ALK and EGFR mutations. Pembrolizumab (KEYTRUDA) brings on unprecedented clinical benefit in various cancer types
The Role of Immunity in Chemotherapy-Resistant Patient with Pembrolizumab: A ...semualkaira
Approaches are limited for treating advanced Non-Small-Cell Lung Cancer (NSCLC) with multidrug resistance but without ALK and EGFR mutations. Pembrolizumab (KEYTRUDA) brings on unprecedented clinical benefit in various cancer types.
Stem Cell Transplantation in Hodgkin’s Lymphoma Past, Present and FutureAmir Abbas Hedayati Asl
Treatment for HL has improved significantly since the ABVD chemotherapeutic combination was invented over 30 years ago .
Despite using the same ABVD regimen in most patients treated in the first line, we now have a much better understanding of disease biology and the late side effects of therapy, and we have moved toward a personalized, risk-adapted approach.
This approach promises to deliver low toxicities and high cure rates for lower risk patients while reserving aggressive regimens for those high risk patients who really need them.
For the minority of patients who fail first-line therapy, novel drugs like the antibody-drug conjugate BV and immunotherapies with nivolumab and pembrolizumab have produced high response rates and durability of benefit.
Further research is needed to determine whether these novel drugs could make life better for both patients with HL who are undergoing treatment and for the growing cohort of HL survivors.
Hairy Cell Leukemia (HCL) is a rare subtype of B-cell chronic lymphoid leukemia which was first described by Bertha Bouroncle in 1958 [1]. The annual incidence of HCL is approximately 0.3 cases per 100,000 and the disease comprises 2-3% of all leukaemia?s in the Western world [2,3]...
Hairy Cell Leukemia (HCL) is a rare subtype of B-cell chronic lymphoid leukemia which was first described by Bertha Bouroncle in 1958 [1]. The annual incidence of HCL is approximately 0.3 cases per 100,000 and the disease comprises 2-3% of all leukaemia?s in the Western world [2,3]...
Hairy Cell Leukemia (HCL) is a rare subtype of B-cell chronic lymphoid leukemia which was first described by Bertha Bouroncle in 1958 [1]. The annual incidence of HCL is approximately 0.3 cases per 100,000 and the disease comprises 2-3% of all leukaemia?s in the Western world [2,3]...
Hairy Cell Leukemia (HCL) is a rare subtype of B-cell chronic lymphoid leukemia which was first described by Bertha Bouroncle in 1958 [1]. The annual incidence of HCL is approximately 0.3 cases per 100,000 and the disease comprises 2-3% of all leukaemia?s in the Western world [2,3]...
Hairy Cell Leukemia (HCL) is a rare subtype of B-cell chronic lymphoid leukemia which was first described by Bertha Bouroncle in 1958 [1]. The annual incidence of HCL is approximately 0.3 cases per 100,000 and the disease comprises 2-3% of all leukaemia?s in the Western world
1. RECENT ADVANCES IN TREATMENT OF LYMPHOMA Presenter: Tanoy Bose Post graduate student Moderator: Dr. B.C.Kalita Assistant Professor The Department of Medicine Assam Medical College, Dibrugarh The 29th of October 2008
2. WHAT ARE LYMPHOMAS? They are cancers arising from the cells of the immune system at different stages of differentiation, resulting in a wide range of morphologic, immunologic, and clinical findings Some almost always present as leukemia (i.e. primary involvement of bone marrow & blood), while others almost always present as lymphomas (i.e. solid tumors of the immune system) Clinical pattern can change over course of illness: more often in patients suffering from lymphoma and then develop the manifestations of leukemia over the course of the illness.
3. BACKGROUND: Represent 4% to 5% of all new cancer cases. The fifth leading cause of cancer death in the United States and the second fastest growing cancer in terms of mortality. The highest reported incidence rates are in the United States, and also Europe and Australia; the lowest rates have generally been reported in Asia Seow A, Lee J, Sng I, et al. Non-Hodgkin's lymphoma in an Asian population: 1968–1992 time trends and ethnic differences in Singapore. Cancer 1996;77(9):1899.
5. Distribution of various subtypes of non-Hodgkin's lymphoma in India: A study of 2773 lymphomas using R.E.A.L. and WHO Classifications.Annals of Oncology. 11 Supplement 1:S63-S67, 2000.Naresh, K. N.; Srinivas, V.; Soman, C. S.
6. The distribution of NHL subtypes in India shows important differences with those from the rest of the world. Follicular lymphoma and mantle-cell lymphoma are less common in India compared to Europe and the USA. Peripheral T-cell lymphomas and T/NK-cell lymphomas of nasal and nasal types, which are common in many other Asian countries, are also less prevalent. T-cell lymphoblastic lymphoma and anaplastic large T/null cell lymphoma are more prevalent in India.
10. The therapeutic options till date & the Problem Statement Therapeutic options till date included systemic chemotherapy either single drug or combination, radiation and bone marrow transplantation. The most common NHL , DLBCL responds well to combination chemotherapeutic regimen like CHOP or CVP. The problem in treating lymphomas are Indolent lymphoma Poor response to first line therapy Lyphomas which are refractory to standard therapeutic regimen.
11. Multiple agents are now under clinical investigation as a therapeutic alternative for these patients. One of these, the immunomodulatory drug lenalidomide, has shown promising activity in both phase I and II clinical trials. Other agents currently under development for NHL include the alkylating agent bendamustine, the proteasome inhibitor bortezomib, and the radioimmunotherapeutic drug 90Y-ibritumomab tiuxetan. The results of several of these studies are summarized in the following abstract reviews.
12.
13.
14.
15. Three factors: Tumor burden, Time since last Rituximab dose, and Absolute lymphocyte count were predictive of patient response to lenalidomidemonotherapy.
16. Low disease burden, estimated by tumor size, was associated with a superior benefit from lenalidomide treatment
17. Significantly, patients with favorable values for both disease burden (<50 cm2 tumor) and time since last rituximab dose (≥230 days) had a statistically higher objective response rate compared to patients with unfavorable values for both
18.
19. The duration of response ranged from 2+ to 8+ months.
20. Importantly, in the 2 patients with previously documented refractory disease, 1 patient had a PR that lasted 6 months and the second patient exhibited SD
21.
22.
23. The therapeutic options till date & the Problem Statement The use of extended field radiotherapy and/or alkylating agent-based chemotherapy, e.g. MOPP (mustine, vincristineprocarbazine, prednisone), has resulted in high long- term disease free – and overall – survival rates for patients with Hodgkin’s lymphoma. However, it is now recognised that each of these treatments is associated with significant long-term toxicity – of major importance in a disease which mainly affects young adults. The use of radiotherapy, particularly to the mediastinum, produces an increased risk of second malignancies such as lung and breast cancer, pulmonary fibrosis, and coronary heart disease. The use of alkylating agent-based chemotherapy increases the risks of secondary leukaemia, non-Hodgkin lymphoma, infertility, and premature ovarian failure. A major emphasis of recent trials in Hodgkin’s lymphoma has therefore been to reduce radiation fields, and to introduce alternative chemotherapy regimens containing fewer alkylating agents
24.
25.
26.
27. Therapy for NHL has significantly evolved over the last decade. While systemic treatments consisted primarily of cytotoxic chemotherapy for many years, the development of the anti-CD20 antibody rituximab has ushered in the era of targeted therapy. Since about 90% of NHL cases are of B-cell origin and therefore express the CD20 antigen, use of this agent is applicable across a broad array of lymphoma subtypes
28. While targeting CD20 with unlabeled antibodies does show activity, it is clear that radiolabeled antibodies offer the potential for augmented activity through targeted radiation. Two such agents, 90Y ibritumomabtiuxetanand 131 I-tositumomab, are approved for use in patients with recurrent indolent lymphoma An additional strategy beyond single-agent use is to employ radiolabeled antibodies after chemotherapy in an attempt to extend remission and enhance survival
29. The approach presented at ASH included CHOP-R treatment followed by 90Y ibritumomabtiuxetan in initial treatment of MCL. Therapy was well tolerated and response rates were high, but additional follow-up will be needed to determine whether long-term outcomes are enhanced by the consolidative therapy
30. Recently, bortezomib was FDA approved for the treatment of recurrent MCL and recent data demonstrated that remission duration can be substantial in a subset of patients. Ongoing studies, including those that combine bortezomib with rituximab in recurrent indolent lymphoma and with CHOP-R in upfront DLBCL and MCL, as well as other trials evaluating bortezomib maintenance, seek to define the best setting for its use
31. Recent trials have shown that lenalidomide is well tolerated as therapy in both indolent and aggressive lymphoma, with overall response rates as high as 53% in the latter subtype. Notable activity has been noted in patients with recurrent DLBCL, MCL and T-cell histologies. One can anticipate an extensive evaluation of lenalidomide in lymphoid malignancies in the near future, and it appears that this agent may have a potentially significant impact in these settings
32. Various data suggest that bendamustineoffers a potentially useful new option for patients with disease that has become resistant to other cytotoxics and rituximab This study warrants close attention, and if efficacy data hold up in the longer term, one can envision that this may be a very useful option for the initial treatment of indolent lymphoma, in particular with respect to the favorable safety profile and allowance to defer anthracycline treatment (and its associated toxicity).
34. While we continue to explore treatment options that appear to have targeted or specific mechanisms of action, it is clear that some agents with generalized effects will continue to have important therapeutic roles. Considerable challenges remain in determining the optimal setting for the use of novel agents, including their combination and sequence with standard therapies. Accrual to ongoing and future clinical trials should remain a priority so that we may rapidly sort out the best use of these new strategies