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How I treat CLL up front, 2010 John G. Gribben
Full text:
http://bloodjournal.hematologylibrary.org
But it may open on page 2.
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Overview: Stem Cell Transplant in Follicular Lymphoma
PAL |
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Personality Does Not Influence Cancer; Hypothesis
Should Be Retired
http://bit.ly/9m78qV |
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Conflict of Interest in Medical Decision-making
PAL |
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Zevalin as a Single Agent in Patients With Pretreated
B-Cell Lymphoma: Evaluation of the Long-Term Outcome
http://bit.ly/doQm0a
Overall response rate was
93% (53 of 57); complete response (CR) rate was 70% (40 of 57).
Twenty-six of 40 patients (65%) who obtained a CR are in continuous CR (CCR)
with a median follow-up of 20 months (range, 10-42 months); 4 of them
still maintain their CCR after 36 months.
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Evolving Questions in Follicular Lymphoma Highlighted
at International Hematology Meeting
http://bit.ly/90NUp5
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Treatment-decisions - schema
PDF |
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Deep Venous Thromboses in Patients With Hematological
Malignancies After Peripherally Inserted Central (PICCs) Venous
Catheters
http://bit.ly/97jQtl
For patients with
hematologic cancer, changing from peripherally inserted central
catheters (PICCs) to centrally inserted tunneled, internal jugular
catheters dramatically reduced the incidence of catheter-associated deep
venous thrombosis. |
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Reassessing the Standard of Care in Indolent Lymphoma:
A Clinical Update to Improve Clinical Practice
CME/CE
medscape.com
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Health Insurers Break Profit Records
as 2.7 Million Americans Lose Coverage
http://bit.ly/92JBoC
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study of interest: Lenalidomide In Previously
Untreated, Advanced Stage Indolent Lymphoma
http://bit.ly/b3xIvp |
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Role of Radiation Therapy in Localized Aggressive
Lymphoma
jco.ascopubs.org |
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Webcam presentation by
registered dietician, Susan Dixon, Cancer Nuitrition specialist
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Radioimmunotherapy for Other Lymphoma Subtypes and Indications
PAL |
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High Rates of Durable Responses in Relapsed NHL With Anti-CD22
Fractionated Radioimmunotherapy
http://bit.ly/9IbqxW
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Study Finds Consumers Need Education
Regarding Evidence-based Care
http://bit.ly/99N18b
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NEJM: Buying Health Care, the Individual Mandate, and the
Constitution
http://bit.ly/9FElMG
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Comments on the PRIMA
study and how to measure success of first line maintenance Rituxan
PDF
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GS-9219 A Novel agent with Potent Antineoplastic Activity in Dogs with
Spontaneous NHL
http://clincancerres.aacrjournals.org
About nucleotide analogue GS 9219 (NCI)
Formulated to
selectively accumulate in lymphocytes, nucleotide analogue GS 9219 is
converted to its active metabolite, PMEG diphosphate (PMEGpp), via
enzymatic hydrolysis, deamination, and phosphorylation; subsequently,
PMEGpp is incorporated into nascent DNA chains by DNA polymerases, which
may result in the termination of DNA synthesis, S-phase cell cycle
arrest, and the induction of apoptosis in susceptible lymphoma cell
populations.
A Trial of GS-9219 in CLL, NHL or MM
http://clinicaltrials.gov
(has
completed enrollment) |
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The effects of β-glucan on human immune and cancer cells
Chan, et al. J Hematol Oncol. 2009; 2: 25. http://bit.ly/cIBT0P
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Targeted Therapies for Lymphoma
Tutorial, NCI http://bit.ly/cF17bg
A bit advanced, but with excellent illustrations and good background on
lymphomas. |
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Walking the Tightrope of Health Insurance Reform between 2010 and
2014 http://bit.ly/azJJgH
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Clinical Questions that can only be answered by trials
PDF
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Beautifully written. I
expect this piece will resonate with patients and experts alike.
Musings of a Distractible Mind:
Thoughts of a moderately strange (yet not harmful) primary care
physician.
A Letter to Patients With Chronic Disease
http://bit.ly/b68MKj
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Response to Second-line Therapy Defines the
Potential for Cure in Patients with Recurrent DLBCL: Implications for the Development of Novel
Therapeutic Strategies
http://www.medscape.com/viewarticle/723577
"No clear indication exists that palliative approaches are
inferior to further intensive approaches in this setting. This
fact may make a comfort-directed or investigational strategy
more acceptable to some patients, because they do not risk
losing the chance for a cure by choosing an alternative to
established standard chemotherapy regimens."
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A 19 page comic strip explanation of homeopathy
http://bit.ly/bYNidX
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Targeting PD-1 to modulate immune
response against lymphoma
Clinical Report:
http://bit.ly/a3lHUc
Clinical Trials:
http://bit.ly/1Bj7r1
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CHOP-R + bortezomib (Velcade) as initial therapy for DLBCL
http://bit.ly/9ifYVY
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Survey Results:
Patient Preference of
Chemo-based Therapy
following
Relapse
of indolent follicular lymphoma (Completed)
PAL |
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Advocacy Alert: Contact your
Elected representatives - ask them to support House Resolution 143 to make
September Blood Cancer Awareness Month.
PAL |
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Panobinostat Produces Objective Responses in Advanced Hodgkin's Lymphoma
http://bit.ly/bHEBIb
"Of 129 patients, 4
(3%) had a complete response to panobinostat, 29 (22%) had a partial
response (defined as a reduction of tumor size by a least 50%), and 111
were deemed to have disease control (defined as a combination of
complete and partial responses and stable disease)
A ceiling is likely going to be reached in relapsed/refractory patients,
and the major questions are going to be: Is there sufficient independent
activity for efficacy, such as in maintenance?" he said. "Is there
synergy, and is it feasible to combine this agent with other therapies?
And are there predictive biomarkers?"
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Studies recruiting for DLBCL, not
eligible for transplant http://bit.ly/aVbuVF
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Study of interest: Combination Veltuzumab (Anti-CD20) and Fractionated
90Y- Epratuzumab (Anti-CD22) Radioimmunotherapy in Patients With
Follicular Lymphoma
http://bit.ly/c80PPu
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Transparency at the Food and Drug Administration
http://bit.ly/cGqhip
"More than 30 years ago,
FDA Commissioner Donald Kennedy noted "a basic principle of
our political system [is] that people affected by
governmental decisions have a right to know the basis on
which they are made." With the daily practice of medicine
routinely affected by the decisions of the FDA, the medical
community has a large stake in transparency at the agency. The
full set of draft proposals can be found on the FDA's Web site
(www.fda.gov/transparency)."
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What is responsible for the recent improvements in outlook for
patients with follicular lymphoma?
http://bit.ly/dev1l0
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Hitting the sweet spot for lymphoma
http://bit.ly/d7bnsS
Targeted
delivery of liposomal doxorubicin to CD22.
“As envisioned by scientists as far back as the 1800s, the
ideal chemical therapy would possess exquisite selectivity,
thereby restricting, if not eliminating, collateral cellular
damage (eg, Ehrlich's "magic bullet").”
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"Natural Cancer Treatments," a Review by Steven Novella,
MD. http://bit.ly/c6T5IU
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ASCO 2010 Wrap-up: Converting Cancer to a Chronic Disease
medscape.com
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Marginal zone lymphomas - Factors that affect outcome
interscience.wiley
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Questions to ask about drug risks, Harlan M. Krumholz MD, SM,
http://bit.ly/bP4BLA
"Doctors cannot tell you
what will happen. The best they can do is to be clear about what is
known about the options -- and what remains uncertain."
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The Path to Personalized Medicine
http://bit.ly/amxlBF
Margaret A. Hamburg, M.D., and Francis S. Collins, M.D., Ph.D.
As the leaders of the
National Institutes of Health (NIH) and the Food and Drug
Administration (FDA), we have a shared vision of personalized
medicine and the scientific and regulatory structure needed
to support its growth. Together, we have been focusing on the
best ways to develop new therapies and optimize prescribing by steering patients to the right drug at the right dose at
the right time. |
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The Interface Between Cancer and Psychiatry
http://bit.ly/d8JSoj
"As
a psychiatrist who has lymphoma, I have developed a deep understanding
of the ways in which our training can help us help patients who find
themselves forced to deal with the complicated emotional aspects that
accompany various forms of cancer. ...
Cancer is an alienating and existential experience. I know of no other
common disease that immediately causes so much fear, anxiety,
depression, confusion, and sense of impending disaster in a patient or
his or her significant others as when they hear the word cancer for the
first time."
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ACS cites studies on Access to Healthcare for Cancer Survivors
http://bit.ly/bYMcXT
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Dr. Cheson: ASCO lymphoma highlights 2010
http://bit.ly/aHIN0Q
Important talk. Do give a
listen. |
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Many studies great news for mice, not so much for humans
us.cnn.com
"In terms of cancer, it is
difficult to translate animal models to human applications because a
human tumor takes several years to develop, and rodent studies often
just inject human tumors into the rat or mouse, said Dr. Gabriel Lopez-Berestein,
professor of medicine and cancer biology at the University of Texas M.D.
Anderson Cancer Center." |
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How to Think about Future Health Care
Spending,
NEJM, Fuchs, Ph.D.
http://bit.ly/cCkLwe
"Lost in the din are two
critical
problems related to future spending — one
empirical, the other conceptual."
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PRIMA data for maintenance Rituxan:
Draft Discussion and Questions
PDF |
Send
Comments |
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Guidelines Call for Cancer Patients to Get Moving
http://bit.ly/bSoetK
"The primary
objective of prescribing exercise to cancer patients and survivors is to
help them regain and improve physical function, said Dr. Schmitz of the
center for clinical epidemiology and biostatistics at the University of
Pennsylvania in Philadelphia. Exercise can also help improve body image
and quality of life for these patients."
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Emotional Patients Do Not Perceive Medical Consultations and Advices
http://bit.ly/axdznz
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Oral green tea in asymptomatic, Rai stage 0-II CLL
AbstView_74_47574
Comment: Here are reported
what appears to be good signals of activity and relatively modest side
effects at the chosen dose (compared to other CLL treatments).
Note that there were also toxicities at what appears to be the active
dose - including signals of liver toxicities - transaminitis (31% grade
1, 12% grade 2), and nausea in 55%. These are modest side effects
compared to standard CLL treatments, but this has to be weighed against
no treatment, because treatment is not given for early stage CLL.
When estimating the treatment effects you need to consider also the
natural history of the condition in the selected population, in this
case early stage CLL ... What is its typical clinical course? Does it
wax and wane? How long until treatment is needed? I think it can be ten
years or more. So are these clinically meaningful responses -
leading to better quality of life or survival? If anything,
quality of life was impaired by the side effects (up to 6 months of
nausea in 55%), so long term impacts on survival - or time to first
treatment (compared to observation in a controlled study) could be the
key questions going forward. |
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Treatment of HIV-associated Hodgkin's lymphoma (HIV-HL): Results of
a prospective multicenter trial
http://bit.ly/9h1Tc3
"Conclusions:
In pts with HIV-HL risk-adapted CT and concomitant HAART is feasible and
effective. However, pts must closely be monitored for neutropenic
infections. These data suggest that the prognosis of HIV-HD may approach
results achieved in the HIV-negative population with HL." (Which
is very good indeed.) |
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Hypogammaglobulinemia (hypogam) in patients receiving Rituxan and
the impact of Rituxan maintenance
http://bit.ly/cYmqll
We identified 215 pts
treated with R for lymphoma between 12/1998 and 4/2009 and also had
quantitative serum immunoglobulin levels (sIg) evaluated prior to and
after treatment with R. Data on the use of IVIG was collected. ...
Rituxan was associated
with developing hypogam in 39% of pts with normal baseline sIg. Pts
receiving RM (Rituxan maintenance) had a significantly higher risk of
developing hypogam and requiring IVIG. The risk of symptomatic hypogam
should be considered in the use of R maintenance.
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Meta-analysis of risk for lymphoma with immunomodulators for
inflammatory bowel disease
http://bit.ly/aFd4kp
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Extranodal lymphomas http://bit.ly/a6AhWt
Emanuele Zucca and Franco
Cavalli |
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Complete response rates with Lenalidomide (Revlimid) plus rituximab
for untreated indolent B-cell NHL
http://bit.ly/dBQerx
"28 pts were
evaluable for response. The overall response rate was 86%.
Complete responses (CR)
were attained in 79% (65% CR/14% CRu) of pts, 2 pts (7%) had a partial
response, and stable disease was seen in 4 (14%). Response rates were
impressive in follicular lymphoma, with nearly all patients 16/17 (94%)
attaining a CR. At a median follow up of 14.1 (9.7-18.8) months, one
patient experienced progression of disease."
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Lenalidomide (LEN) in patients with transformed lymphoma: Results
from a large international phase II study (NHL-003).
http://bit.ly/a234dx
"LEN has promising
clinical activity and achieves durable responses in patients with TL.
Also, it may be necessary to consider the original histology when
setting a course of therapy for patients with TL. Further studies are
needed in this hard-to-treat population."
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Low Absolute Lymphocyte Count (ALC) associated with relapse in DLBCL
http://bit.ly/cPITVc
"Patients with an ALC
>/=0.96 x 10(9)/l (N=103) had a cumulative incidence of relapse of 6
versus 79% with an ALC <0.96 x 10(9)/l (N=46) (P<0.0001). This study
suggests that lymphopenia measured by ALC can be used as a marker to
assess risk of DLBCL relapse during routine follow-up after standard
chemotherapy.
Comment: As always, it will be important for another group to replicate
the finding. |
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Yoga Eases Sleep Problems Among Cancer Survivors
http://healthday.com/Article.asp?AID=639340
Study found those who
practiced it for four weeks after chemo slept better, used fewer sleep
aids |
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Radioimmunotherapy of Lymphoma: Ahead of Its Time or Past Its
Sell-By Date? http://bit.ly/9x2RgL
Tim Martin Illidge, School
of Cancer and Imaging Sciences, Manchester Academic Health Sciences,
University of Manchester, Manchester, United Kingdom
As we look to the future, few things are certain, but we can be sure
that there will continue to be increasing numbers of patients with
follicular lymphoma who are refractory to both chemotherapy and
rituximab. For the latter group, there are compelling data that RIT can
play an important role in both chemotherapy- and rituximab refractory
disease, leading to high response rates with durable remissions.
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Improved survival in patients with early stage low-grade follicular
lymphoma treated with radiation therapy (RT)
http://bit.ly/cHNXNh
N = 6,568.
Overall Survival at 5, 10, 15, and 20 years in the RT
group was 81%, 62%, 45%, and 35% versus 71%, 48%, 34%, and 23% in
patients not receiving RT. RT for early stage low-grade follicular
lymphoma is greatly underused in the US population; increased use of
upfront RT could prevent thousands of deaths from lymphoma in these
patients. |
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Poverty of Riches - analysis of number of lymphoma studies versus
available patients PDF
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Radioimmunotherapy Consolidation in Mantle Cell Lymphoma
http://bit.ly/9kt6WK
PDF http://bit.ly/c7HIxm
Wojciech Jurczak, European
Oncological Disease - Published: October 2008
A thorough description of the rationale for consolidation with RIT for
MCL – but also informative for other lymphomas.
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Orac: The never-ending saga of DCA -
dichloroacetate as a cancer treatment
http://bit.ly/cbfTVJ
"I don’t say this because
I want DCA to fail; I say it because I would very much like to see DCA
succeed." |
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Rituximab Maintenance Treatment of Relapsed/Resistant Follicular
NHL: Long-Term Outcome of the EORTC 20981 Phase III Randomized
Intergroup Study http://bit.ly/9mVxh5
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CVP followed by Bexxar in Untreated
Follicular Lymphoma:
Eight-Year Follow-Up of a Multicenter Phase II Study
http://bit.ly/chKTgk
After a median follow-up of 8.4 years, the median
response duration had not been reached (range, 3 to 111+ months).
COMMENT: Encouraging, but once again, we have a Bexxar study design that
suffers from being small (n=30) and having no randomized comparator –
such as CVP-R. Further it supports the FIT study which demonstrated
that chemo followed by RIT consolidation is very much worth considering
– that study used Zevalin.
Regarding the risk factors in this study population, which is a problem
when comparing results across studies (historical controls) – that 15 of
the participants had bulky disease suggests that at least 50% had high
risk FL. ~ KarlS (layperson perspective)
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Lifestyle Factors Significantly Impact
Survival Of Lymphoma Patients
http://bit.ly/cZZB7S
"Most importantly, we
didn't answer the question of whether changing these factors after
diagnosis would impact survival," he says. "That is best done with a
clinical trial." |
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Gene Expression Signature of Host Immune
Response Is Predictive of Follicular Lymphoma Patient Survival in
Independent Cohorts, and Correlates with Transformation to Diffuse Large
B-Cell Lymphoma
ASH 2009
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Statin Use by Donors May Protect Stem Cell
Transplant Patients From Graft Versus Host Disease
http://bit.ly/8ZNK88
In a retrospective
study of 567 patients who underwent hematopoietic cell transplantation
from matched sibling donors between 2001 and 2007, patients whose donors had been taking statins at the
time of stem cell donation experienced no severe acute GVHD.
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REDUCING ENVIRONMENTAL CANCER RISK
What We Can Do Now
http://bit.ly/bAe3hu
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Too many vitamin tablets could be bad for your health
http://bit.ly/aeM43O
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Wilm's Tumor 1 Protein Vaccine ... for relapsed NHL after allo SCT
Patients with the blood antigen HLA-A2 and the WT1 cancer protein who
have persistent or recurrent blood cancers after [allo] stem cell
transplantation.
Background: "Most patients [with blood cancers] including NHL have a
protein called Wilm's Tumor 1 (WT1) in their cancer cells. This protein
is thought to be able to influence the growth of these cancers.
A vaccine made with the WT1 protein may boost the immune system to help
fight these cancers in patients whose cancer cells contain the protein."
http://bit.ly/cGFFDG
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Low Dose Naltrexone – Bogus or Cutting Edge Science?
http://bit.ly/aIACkO
A scholarly examination of how “science is abused in the pursuit of
health (or making money from those who are pursuing health).”
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Primary Radiation Therapy in Patients With Localized Orbital
MALT Lymphoma
http://bit.ly/9YUyKD
Forty-three patients (93%)
achieved complete remission (CR), and three patients (7%)
achieved partial remission (PR). Five-year relapse-free
survival, cause-specific survival, and overall survival were
93%, 100%, and 100%, respectively.
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CD3 immunotoxin therapy of cutaneous T cell lymphoma
http://bit.ly/b8Wvma
This novel immunotoxin has
dramatic clinical activity even at the lowest dose in CTCL patients and
merits applications at higher doses in CTCL and other CD3+ T cell
leukemia/lymphoma patients. The lymphodepletion with recovery of T
regulatory cells suggests the drug may be beneficial for
immunosuppression of T cell autoimmune disorders.
Clinical trials:
http://bit.ly/cz7jlZ
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Dr. Brad Kahl of the University of Wisconsin talking about
results/findings from Dec. '09 ASH conference
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A User's Manual For The IOM's 'Quality Chasm' Report
http://bit.ly/bTZGZe
Patients' experiences
should be the fundamental source of the definition of "quality."
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NCCN Survey of Clinicians: at Least Half of Their Patients Have
Difficulty Paying for Treatment
http://bit.ly/cwema3
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Medication Checklist by PAL
PDF
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Radioimmunotherapy review article
http://bit.ly/d181ic
"Currently in the United States, RIT is mainly used in
the salvage setting; however, emerging data suggest that to enhance
patient benefit, RIT should be administered earlier in the treatment of
follicular lymphoma. In an analysis of 1,177 patients treated with
131I-tositumomab, the ORR, CR rate, and duration of response decreased
as the number of prior therapies increased."
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Allogeneic stem cell transplantation in follicular lymphoma:
recent progress and controversy
http://bit.ly/9QY8aa
"Allogeneic stem cell transplantation (allo HCT) is a
curative treatment for follicular lymphoma, but is hampered by a
relatively high treatment-related mortality and by difficulties in
identifying high-risk groups for whom transplant is warranted."
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Gene Mutations Reveal Potential New Targets for Treating aggressive
form of NHL http://bit.ly/9DUMQ2
When a normal B cell
encounters a foreign substance, proteins on the cell surface known as B
cell receptors (BCR) activate signaling pathways that tell the cell to
survive and proliferate. A signaling pathway is a stepwise series of
biochemical events that help regulate important cellular functions, such
as proliferation and survival. Each pathway contains points at which
normal signaling can become altered, causing cells to function
abnormally. Alterations in signaling pathways have been found in many
types of cancer cells. Previous research had suggested that BCR
signaling might contribute to the development of lymphomas; however,
direct genetic and functional evidence was lacking.
In the new study, researchers first used advanced laboratory techniques
to identify critical points in the BCR signaling pathway that affect the
survival of lymphoma cells. They found that interference with several
individual components of this pathway caused lymphoma cells to die.
Thus, ongoing BCR signaling -- which the authors refer to as chronic
active signaling -- is necessary for ABC subtype DLBCL cell survival.
Clinical trials: Dasatinib and NHL OR CLL
http://bit.ly/a5HDEd
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Analysts: about two million people will be
eligible for enrollment in the high risk Health Insurance pool
http://bit.ly/9hQv0e
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What's in the Health Care Bill?
http://bit.ly/bCqr6h
Selected Highlights for patients:
This year, adults who are uninsured because of pre-existing
conditions will have access to affordable insurance through a
temporary subsidized high-risk pool.
This year, insurance companies will be banned from dropping people
from coverage when they get sick, and they will be banned from
implementing lifetime caps on coverage.
Once the new health insurance exchanges begin in the coming years,
pre-existing condition discrimination will become a thing of the
past for everyone.
This year, health care plans will allow young people to remain on
their parents' insurance policy up until their 26th birthday.
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PET - Clinical Use Overview
PAL
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Anthracycline-Induced Cardiotoxicity
http://bit.ly/aZOuVR
“The incidence of congestive heart failure secondary to
doxorubicin-induced cardiomyopathy depends on the cumulative dose of
the drug.
At total doses of less than 400 mg/m2 body surface area, the
incidence of congestive heart failure is 0.14%; … this
incidence increases to 7% at a dose of 550 mg/m2 body surface area
and to 18% at a dose of 700 mg/m2 body surface area [6] (Figure 1).
The rapid increase in clinical toxicity at doses greater than 550
mg/m2 body surface area has made the 550-mg dose the popular empiric
limiting dose for doxorubicin-induced cardiotoxicity. “
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Lymphoma clinical trials including Gene
expression analysis
http://bit.ly/8Y8lGR
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Advance Care Planning Consultation – text
of Health Care Bill http://bit.ly/blPT63
We have opted for neutrality in the Healthcare
debate, not for lack of heart-felt opinion on it, but to prevent
ideological debates from distracting from our MISSION, which is to
provide support and evidence-based information for lymphoma
survivors no matter his or her ideological beliefs.
What follow is not OUR opinion on the controversial Advance Care
Planning provision in the present Health Care Bill proposal, but the
actual text. The purpose is to allow
you to read it and to judge it first-hand. (The alternative is to
form opinion based on opinion.) Here also is a link to the full text
of the proposed bill:
http://docs.house.gov/edlabor/AAHCA-BillText-071409.pdf
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