Blood Cancer brings you information of interest to patients and families impacted by lymphoma, leukemia, and myeloma.
A new study by Dr. Leo Gordon, M.D. at Northwestern shows that synthetic HDL nanoparticles killed B-cell lymphoma in cultured human cells and inhibited human B-cell lymphoma tumor growth in mice. “This has the potential to eventually become a nontoxic treatment for B-cell lymphoma which does not involve chemotherapy,” according to Dr. Gordon! Here is a link for more information on this exciting development.
Promising New Leukemia Treatment & Possible Cure For CLL: Researchers engineered a patient's own immune cells to treat a type of blood cancer called chronic lymphocytic leukemia, or CLL. "The clinical doctor involved in this was astonished and so were the patients that a single infusion of the cells could have such pronounced anti-tumor effects in the patients," Dr. June says. So far all 3 patients - who had incurable leukemia and no other options - are doing well about a year after treatment.
Relapsed/Refractory Leukemia Responds to Experimental Inotuzumab
The investigational conjugated monoclonal antibody inotuzumab ozogamicin (In-oh-TOO-zoo-mab OH-zoh-ga-MY-sin) delivered weekly produced a high objective response rate in heavily pretreated patients with relapsed or refractory acute lymphocytic leukemia, investigators reported.
"Inotuzumab ozogamicin is very active in relapsed/refractory ALL. We're reporting an objective response rate of 52%, most likely the highest activity for a single agent in this setting," said Dr. Elias Jabbour of the department of leukemia at the University of Texas M.D. Anderson Cancer Center, Houston.
Inotuzumab ozogamicin is anti-CD22 monoclonal antibody conjugated to calecheamicin, a cytotoxic antibiotic. The investigators recently reported that the compound, delivered at a dose of 1.8 mg/m² IV over 1 hour once monthly, was associated with a 57% overall response rate in 49 patients, but with a dose-limiting toxicity of thrombocytopenia (Lancet Oncol. 2012;13:403-11).
The current study was designed to see whether lower but more frequent doses might offer better anti-ALL activity and have a better safety profile, as suggested by preclinical studies. Dr. Jabbour presented the results at the annual meeting of the American Society of Clinical Oncology.
The investigators enrolled adults and children with relapsed/refractory CD22-positive ALL and treated them with inotuzumab 0.8 mg/m² on day 1 and 0.5 mg/m² on days 8 and 15; they repeated Three of the patients had a complete remission (CR), defined as the disappearance of all clinical and/or radiologic evidence of disease, a neutrophil count greater than 1.0 × 109/L, a platelet count greater than 100 × 109/L, and normal marrow differential with less than 5% blasts. Eight patients had complete remission except for platelet recovery (CRp) and three had a complete remission in marrow but without recovery of neutrophil or platelet counts (CRi), Dr. Jabbour said.
Eleven patients had disease resistant to the therapy and two died within 4 weeks of treatment.
Among patients evaluable for cytogenetic response, there were responses in two of two patients with a complete remission, in five of six patients with a CRp, and in two of two with a CRi. Of 14 patients evaluable for minimal residual disease (MRD), three of three with a CR were MRD negative, as were seven of eight with a CRp and one of three with a CRi. In all, 11 of the 27 patients in the analysis were MRD negative, he reported.
Median progression-free survival and median duration of response were 5 months each. Median overall survival was 7 months and did not differ significantly when patients were censored at the time of transplant. Median overall survival in this study compared favorably with that of the once-monthly dosing schedule (5 months).Adverse events included infusion-related fever (grade 1/2 in three patients and grade 3/4 in four) And hypotension (grade 1/2 in one patient). There was one case of grade 1/2 bilirubin elevation, six grade 1/2 liver enzyme elevations, and two grade 3/4 enzyme elevations. All of the liver changes were reversible.
Prognostic factors for worse outcome were three or more salvage regimens and Philadelphia chromosome positivity.
Dr. Bruno Medeiros of Stanford ( Calif. ) University, the invited discussant, commented that intozumab has "impressive" single-agent activity in relapsed/refractory ALL, and that it appears to be safe before allogenic transplant. It remains to be seen whether the agent may have efficacy when combined with chemotherapy or other monoclonal antibodies in the relapsed and front-line settings, or activity when used as a single agent up front, he said. Dr. Jabbour disclosed ties with Pfizer, which funded the study. Dr. Medeiros disclosed ties with Milennium, Celgene, and Novartis.
CT Scans in Kids Linked to Leukemia, Brain Cancer Risk
"Radiation exposure from CT scans was associated with an increased risk of brain cancer and leukemia, and that risk increased with increasing levels of radiation exposure," said Amy Berrington de González, a radiation epidemiologist at the National Cancer Institute in Bethesda, Md., and co-author of the study published in The Lancet as reported by ABC News.
The study, of more than 355,000 children and teens in the U.K., found those exposed to 60 milligrays of radiation - the cumulative dose of two brain CT scans - were three times more likely to develop brain tumors. Those exposed to 50 milligrays of radiation were three times more likely to develop leukemia, a cancer of the white blood cells produced in the bone marrow.
Berrington de González stressed that the absolute cancer risk is very small, accounting for one extra cancer case per 30,000 children scanned. "Providing the scan is clinically justified and performed properly with a child size dose of radiation, the benefits should easily outweigh the risks," she said.
But for parents like Baker, forced to quickly weigh the immediate benefits with the long term risks, the decision is far from easy.
Radiation has long been known to cause DNA damage that can lead to cancer. But the cancer-causing effects of doses doled out during CT scans were purely theoretical.
"Those estimates drew a lot of controversy because they were based on the cancer risk in atomic bomb survivors," said Dr. David Brenner, director of ColumbiaUniversity's Center for Radiological Research and lead author of the 2001 study estimating the cancer risk from CT scans. "There was debate about whether the risks were real, and this study shows pretty unequivocally that they are."
But Brenner said the benefits of CT scans, namely their ability to quickly detect life-threatening problems and guide life-saving surgeries, indeed outweigh the risks.
"All medical procedures have risks and benefits," he said. "That said, there are situations where CT scans are being used too much."
Brenner estimates some 20 percent of the country's 80 million CT scans each year are either unnecessary or could be replaced by a radiation-free ultrasound or MRI.
"That's why we need basic guidelines; decision rules that determine when a CT scan is medically appropriate," he said, adding that such guidelines already exist but are not always used.
Dr. Andrew Einstein, director of cardiac CT research at ColumbiaUniversityMedicalCenter in New York City and author of an editorial accompanying the study, said he hopes doctors to think twice before ordering CT scans in children and parents will ask about alternatives.
"I think we need to redouble our efforts to ensure patients are getting appropriate tests with the lowest radiation dose possible," he said. "There are good reasons to use CT scans; it's a lifesaving test for many people. But with every good thing in medicine, there's a potential downside. And for CT scans it's the radiation."
There Are Nearly 14 Million Cancer Survivors In America
Survivors are defined as any person with cancer from the time of diagnosis on, There are an estimated 13.7 million Americans alive today who have a history of cancer, and that this number is expected to grow to nearly 18 million by 2022. Much of this growth is related to the increase in the US population, but also to the fact that the fastest-growing segment of the population is persons age 70 and older, the age group when most cancer diagnoses occur. Close to half of all cancer survivors are over the age of 70, while only 1 in 20 is less than 40 years old. Nonetheless, there are nearly 60,000 survivors of childhood cancers living in the United States (and 12,060 children will be diagnosed with cancer in 2012).
Approximately 34% of cancers in children are leukemias and 27% are brain and other nervous system cancers. Other cancers in children include: Neuroblastoma (7%), a cancer of the nervous system that is most common in children younger than 5 years of age and usually appears as a swelling in the abdomen; Wilms tumor (5%), a kidney cancer that may be recognized as a swelling in the abdomen; Non-Hodgkin lymphoma (4%); and Hodgkin lymphoma (4%), which affect lymph nodes and may spread to other organs.
Estimated Numbers of US Cancer Survivors by Site Source (2012):
Male:
Prostate 3,922,600 (45%)
Colon & rectum751,590 (9%)
Melanoma 661,980 (8%)
Urinary bladder 548,870 (6%)
Non-Hodgkin lymphoma 371,980 (4%)
Kidney & renal pelvis 300,800 (3%)
Testis 295,590 (3%)
Oral cavity & pharynx 232,330 (3%)
Lung & bronchus 231,380 (3%)
Leukemia 220,010 (3%)
All sites 6,442,280
Female:
Breast 2,971,610 (41%)
Uterine corpus 606,910 (8%)
Colon & rectum 603,530 (8%)
Melanoma 496,210 (7%)
Thyroid 436,590 (6%)
Non-Hodgkin lymphoma 255,450 (4%)
Uterine cervix 245,020 (3%)
Lung & bronchus 223,150 (3%)
Ovary 192,750 (3%)
Urinary bladder 148,210 (2%)
All sites 7,241,570
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