This page concerns Diffuse large B cell lymphoma, a type of non-Hodgkin's lymphoma. Although I have some background in research (Ph.D. in experimental nuclear physics), I have no medical training. Updated 28 Aug 01.
I had not updated this lymphoma material in substance since 28 Aug 01, for reasons set out on the Lymphoma gateway page (Lymph010). I shall now (17 Dec 01) resume adding information.
Go Home. ___ Go to Table of contents for Health.
. . . Diffuse large B cell lymphoma
. . . 131-I-anti-B11D10 ___ 2CDA and Topotecan ___ acupuncture ___ Alternative names for some lymphomas
. . . Alternative therapies ___ Anticode G3139
. . . antisense therapy ___ Armand Keating, MD, Research Site, Toronto clinical trials
. . . Bexxar ___ BLC-2 antisense therapy ___ Blood and Marrow Transplant
. . . Cancer ___ CANCER RELATED LINKS of wide scope and number; excellent! ___ Cases ___ CD20
. . . CD20 cell-surface antigen ___ Clinical trials ___ coenzyme Q10 ___ Consultation online ___ Contacts
. . . Cytokines ___ Drugs database ___ General medical links ___ Gleevec treatment approved ___ Hu1D10
. . . idiotypes ___ Intron A (Interferon alfa-2b) ___ Iodine-131 Anti-B1 Antibody (Bexxar)
. . . Keratinocyte Growth Factor ___ Lateral thinking and the cure for cancer: Cancer warrior Dr Judah Folkman
. . . Lymphoma in general ___ lymphoma vaccine ___ mucositis ___ New treatments ___ Oncology ___ Organizations
. . . Overview of treatments ___ polysaccharide K ___ Primer on genetics ___ Research ___ Rituxan
. . . Rituximab ___ Rituxan™ (Rituximab) ___ Stem Cell Enrichment ___ Stem Cell Transplant
. . . Tom Baker Cancer Center Clinical Trials, Calgary ___ Topotecan and Mitoguazone (MGBG) ___ Treatment Trials
. . . Various ___ Vincristine Sulfate Liposomes injection treatment trials ___ Zevalin trials
I am jotting down these notes as I proceed in searching the Net. This is a learning experience. See additional links below.
My first stop was MedlinePlus of the National Library of Medicine. The search there for the key phrase Diffuse large B cell lymphoma did not lead to a specific article by that name. It lead to Lymphoma - Hodgkin's see Hodgkin’s lymphoma, and to Lymphoma - non-Hodgkin's see Non-Hodgkin’s lymphoma, on the page http://www.nlm.nih.gov/medlineplus/ency/encyclopedia_Lo-Lz.htm. We are interested only in the latter: Non-Hodgkin’s lymphoma. That links to an overview article, which includes the following:
. . . Illustrations: Images of Lymphoma, malignant - CT scan, and Immune system structures (Lymph nodes, Thymus, spleen).
. . . Alternative names: Lymphosarcoma; Lymphoma - non-Hodgkin's; Lymphocytic lymphoma; Reticulum cell sarcoma; Histiocytic lymphoma; Lymphoblastic lymphoma; Cancer - Non-Hodgkin's lymphoma.
. . . Defintion: A group of malignancies of lymphoid tissue (lymph nodes, spleen, and other organs).
. . . Causes and risks: The cancers vary from indolent disease to rapidly progressive cancer. The cause is unknown, but it may be associated with suppression of the immune system, especially after organ transplantation. The tumors are graded according to their level of malignancy; low grade, intermediate grade, or high grade. Burkitt’s tumor is an example of a high grade lymphoma. The tumors occur more frequently than Hodgkin’s lymphoma. Most often it affects people over 50 years old. High-risk groups include organ transplant recipients and immunosuppressed people. The incidence is 3 out of 10,000 people.
. . . Symptoms, Signs and tests, Treatment, Prognosis, Complications. . . . All with details and links.
If you have non-Hodgkin’s lymphoma, call your health care provider if you experience persistent fever or other signs of infection.
There are other excellent sources of general medical information on the Net, some of which I have gathered together at General medical links. However, for now, let us proceed to a more specific search. A search using Google for the exact phrase Diffuse large B cell lymphoma led to 1,180 sites. Where to begin? I have included several of these sites in Links below.
After looking at only the first ten of these sites, I find the following to be of particular interest, as listed below:
(a) My husband, for an overview, and many links.
(b) Distinct and Diffuse, for the finding that there are two molecularly distinct forms of Diffuse large B cell lymphoma (DLBCL) which had gene expression patterns indicative of different stages of B-cell differentiation.
A search for "new treatment for lymphoma" yielded 26 sites, including information on two new drugs, Bexxar and Rituxan.
For a very detailed and instructive case description, see Cases below.
Searching on "new therapy" lymphoma went to # 49 of 826. More to do yet. 22 Aug 01. To #65 23 Aug 01.
Searching on lymphoma specialists Ontario yielded 500 hits. Went to about #5, 28 Aug 01. Found a new drug being tested: see Keratinocyte Growth Factor.
11 Sep 01. Continued preceding search, now with 542 hits. Found a new drug being tested (see Zevalin); a new treatment approved by the FDA (see Gleevec); and a lead to do a follow-up on measles vaccine contra lymphoma. Went to #36, CANCER RELATED LINKS.
I will be adding more. . .
Diffuse large B cell lymphoma: links
See also Organizations.
CancerNet Credible, current, comprehensive cancer information from the National Cancer Institute: http://www.cancernet.nci.nih.gov
Hospital Practice Non-Hodgkin's Lymphoma: http://www.hosppract.com/issues/1999/12/dmmhab.htm Non-Hodgkin's Lymphoma: Present Status and Future Prospects. THOMAS M. HABERMANN, Mayo Medical School. .Both management and prognosis vary with the many different varieties of non-Hodgkin's lymphoma. In large-cell disease, age and other risk factors influence prognosis. Relapses may respond to chemotherapy plus autologous bone marrow transplantation. Therapy with antibodies to tumor cells has made its debut, but its role remains unclear.
This is a very detailed and instructive case description, including Diagnostic algorithm, and Management algorithm charts.
A new approach to the treatment of non-Hodgkin's lymphoma involves rituximab, a chimeric mouse-human anti-CD20 monoclonal antibody. Rituximab, the first monoclonal antibody available for treatment of a cancer, has been approved for use against follicular lymphomas.
After intravenous injection, rituximab attaches to the CD20 receptor, an antigen that is expressed only on B-lineage cells and is important for cell cycle initiation and differentiation. The mechanism by which rituximab kills the cells is not well understood, but it appears to involve antibody-dependent cell-mediated cytotoxicity and apoptosis. . . .
Pathfinders My life with Lymphoma: http://www.healthtalk.com/len/path/monica1.html . . . Imagine being an athletic woman in your early 20s and finding out you have cancer. When you're young and feeling invincible, . . . This is Andrew Schorr from HealthTalk Interactive and the Lymphoma Education Network, and we're visiting with Monica Tracey, a 12-year non-Hodgkin's lymphoma survivor . . . I was training to do a race, and I started doing a little bit of weight lifting, and shortly after that I felt kind of a pain in my cheek sinus area, and . . . it didn't go away, and so I went to my dentist . . . . although he didn't see anything, he did refer me to someone who specialized in TMJ. And I was really excited when that didn't amount to anything. . . .
so I then went to a regular GP, and he gave me ibuprofen and Tylenol with codeine to sleep through the night, and after three weeks of that -- still hurting quite a bit and increasing -- I went back to the doctor, and he said, "Would you like more medicine, or would you like to see someone else?" . . .
So . . . I saw an ear, nose and throat doctor who could see at that point a little bit of a maybe an ashen gray look right in the back of my mouth, and he said, "You know, it looks like you might have something back there. We need to do a biopsy on it." And of course, still, they said, oh, ten percent chance that it would be a cancer; 90 percent chance that it was nothing. So, obviously, I ended up in the ten percent.
Additional links: Lymphoma Education Network: http://www.healthtalk.com/len/index.html
Jerry's Journey: http://www.canoe.ca/JerrysJourney/canceronthenet.html Cancer on the Net. Scanning the Internet for cancer information. By JERRY ROGERS -- Special to CANOE.
When I got the news I had cancer . . . non-Hodgkin's lymphoma . . . At times, I wonder about the wisdom of the cancer victim doing the research him or herself. It might be better if the spouse or a friend do the literature search while the cancer patient looks after the daily living with cancer or the side effects of the treatment.
But for me, it gives a sense that I'm actively doing something to help myself rather than solely relying on medical treatment team . . .
. . . Jerry was admitted to Toronto's Sunnybrook Hospital this week in preparation for another intensive bout of chemotherapy. He began that five-day course . . .
Today, these are the sites I would go to: (I have also listed these elsewhwere -- e.g., in Organizations.)
Canadian Cancer Society: http://www.cancer.ca/ A good one-source site on cancer, facts and treatments. . . . solid information . . . about cancer and . . . surgery, radiation and chemotherapy.
http://www.healthology.com It's like a news service for all medical topics . . . very aggressive in posting the latest cancer research papers and regularly webcast cancer forums in the U.S.
http://www.medscape.com . . . contains excellent medical reports and journal articles by medical specialists.
http://www.webmd.com . . . a sound guide through the miasma of confusing health news and information . . . It lists a physicians' directory that doesn't really help us in medicare-restricted Canada but it also has condition-specific support groups. That's where I found the Lymphoma Research Foundation of America.
http://www.oncolink.upenn.edu University of Pennsylvania Cancer Center. This has been called the best cancer site in America. It does have a huge article database.
http://www.centerwatch.com Since Canadian medical research more often than not lags that of the U.S., I have not used this site that much. The Ontario government may have put more money into cancer this year but try to get an oncologist to offer experimental and approved drugs in combination with chemotherapy. The main reason is cost. This site offers more than 40,000 clinical trials actively recruiting patients. If nothing else, it provides good enough information to keep your oncologist on top of his game.
http://www.quackwatch.com . . . debunks pseudo science and takes on everything from shark cartilage pills to laetrile, the bogus cancer remedy made from apricot pits for which actor Steve McQueen, for instance, journeyed to Mexico.
http://www.mayoclinic.com/home?id=3.1.5 All of the major cancer care centers in the U.S. have excellent websites but this one from the world-famous Mayo Clinic is likely the best. It has easy to understand sections on cancer.
http://www.cancernet.nci.nih.gov Another excellent site with timely, up-to-date information on cancer diagnoses, treatment options, treatment guidelines, research news and cancer centers where investigators are testing experimental therapies. This is the National Cancer Institute's cancer information service.
http://www.cancer.org . . . American Cancer Society's views on prevention strategies and news on lifestyle issues.
http://www.wellness.net Run by the Cancer Recovery Foundation of America, this is an authoritative and user-friendly site that compares conventional, complementary and alternative treatments. Staff counsellors offer counselling that specializes in integrating body, mind and spirit.
There is much personal material here, and progress reports.
See also My husband below.
Partners Online Specialty Consultations: https://econsults.partners.org/ Partners Online Specialty Consultations is a health care consultation service provided by physicians at Partners hospitals, to physicians in conjunction with their patients. Physicians and patients, nationwide, may arrange remote specialty consultations to support their care by accessing the expertise of our physicians at Massachusetts General Hospital, Brigham and Women’s Hospital and Dana-Farber/Partners CancerCare.
Commentary about this site from NETSURFER DIGEST, Vol. 07, Issue 27, Aug 23, 2001:
Medical Second Opinions via the Web
CNet tells us that doctors in Boston, a city with more than its fair share of internationally renowned healthcare professionals, have started a service that provides medical second opinions via the Internet. Legal restrictions currently limit the service to 27 states and 40 countries. The eConsults operation, run by Partners Health Care System, makes available some 3,000 specialists for a fee of $600 per case. While this online practice has barely started, the previous success of a similar service using other communications technologies suggests that patients will use convenient, affordable access to services of this type. Partners Health Care System says that in the past, its second opinions led to a change of diagnosis 15% of the time and a change in treatment 71% of the time.
Boston doctors count beans from Net advice - Tech News - CNET.com: http://news.cnet.com/news/0-1007-200-6896226.html
Thomas P. Miller, M.D.: http://www.azcc.arizona.edu/whos_who/w_miller.htm Prof. of Medicine, Arizona Cancer Center. The Arizona Cancer Center is one of eight Centers of Excellence housed within the University of Arizona Health Sciences Center complex in Tucson, Arizona.
CANCER RELATED LINKS: http://www.seidata.com/~marriage/rcancer.html#disease Welcome to Cancer Links. It has a very wide and excellent range of links, including many re lymphomas, and the following:
Government Servers ___ Educational Institution Servers ___ Cancer Institutes and Research Centers
Dedicated Cancer Links ___ Medical Links ___ Journals and Newsletters ___ Bone Marrow Transplants
Disease Specific sites ___ Other Cancer Servers ___ Alternative and Complimentary Treatments ___ Cancer FAQ
MEDLINEplus Health Information from the National Library of Medicine - Home Page: http://medlineplus.gov/
HMDS Diffuse Large B-cell Lymphoma: http://www.hmds.org.uk/dlbcl.shtml This is part of a site of Haematological Malignancy Diagnostic Service, Leeds Teaching Hospitals, UK. The diagnosis of leukaemia, lymphoma and related blood disorders by cellular and molecular investigation. The specific page includes CLINICAL FEATURES, LABORATORY DIAGNOSIS, images of stained sections showing odd cells, CYTOGENETICS AND MOLECULAR GENETICS, OUTCOME AND THERAPY, Prognostic Factors.
Distinct Types of Diffuse Large B-Cell Lymphoma Identified by Gene Expression Profiling: http://www.euchromatin.org/Alizadeh01.htm. Published in Nature vol. 403: no. 6769, pp. 503-511 (Feb. 3, 2000). Has about 40 co-authors!
Diffuse large B-cell lymphoma (DLBCL), the most common subtype of non-Hodgkin's lymphoma, is clinically heterogeneous: 40% of patients respond well to current therapy and have prolonged survival, whereas the remainder succumb to the disease. We proposed that this variability in natural history reflects unrecognized molecular heterogeneity in the tumours. Using DNA microarrays, we have conducted a systematic characterization of gene expression in B-cell malignancies. Here we show that there is diversity in gene expression among the tumours of DLBCL patients, apparently reflecting the variation in tumour proliferation rate, host response and differentiation state of the tumour. We identified two molecularly distinct forms of DLBCL which had gene expression patterns indicative of different stages of B-cell differentiation. One type expressed genes characteristic of germinal centre B cells ('germinal centre B-like DLBCL'); the second type expressed genes normally induced during in vitro activation of peripheral blood B cells ('activated B-like DLBCL'). Patients with germinal centre B-like DLBCL had a significantly better overall survival than those with activated B-like DLBCL. The molecular classification of tumours on the basis of gene expression can thus identify previously undetected and clinically significant subtypes of cancer.
See also, related link below, at Diffuse.
Diffuse large b-cell: http://www.wizard.com/NHL/research/diffuse_bcell.htm Scientists Discover Diffuse Large B-Cell is Two Distinct Diseases. National Cancer Inst. Press Release. Feb. 2, 2000.
For pathologists, distinguishing among the many types of B-cell lymphoma has always been a challenge. Current tumor classification systems are based on subtle differences in the appearance of these immune cells under a microscope, leaving many to wonder whether looks sometimes might be deceiving.
But this week in the journal Nature* [See related link above, at Distinct.], a team of scientists report that in the future, there may be a new way around this old problem. Using DNA microarray technology -- a powerful new research tool that can record the expression patterns of thousands of genes at once -- the group was able to show that, as currently defined, diffuse large B-cell lymphoma, the most common form of non-Hodgkin’s lymphoma (NHL), is actually two distinct diseases. . . . Very detailed paper.
Lymphoma Information Network - Welcome: http://www.lymphomainfo.net/ It has the following subpage: . . .
. . . Lymphoma Information Network: http://www.lymphomainfo.net/lymphoma.html# These pages are for those seeking information on lymphoma - Hodgkin's Disease and Non-Hodgkin's Lymphoma. Welcome! This site strives to do two things: put a bit of humanity and understanding to this disease and to gather lymphoma information and resources in one place.
This has a wide range of information and links, including the following recent news:
July 2001 - Zevalin in stage III trials for B cell NHL
June 2001 - Measles Vaccine Causes Non-Hodgkin's Lymphoma Remission in Mice
May 2001 - Gleevec is approved by the FDA - it has been effective in curing numerous cancers, including Leukemia and Lymphoma
3/20/2001 - Bexxar FDA Approval Receives Setback
My husband has recently been diagnosed as having a lymphoma. We asked his doctor for more information and he said it was a diffuse large B-cell lymphoma. Can you tell us what this means?: http://www.cancerbacup.org.uk/questions/specific/lymphomas/nhl/diffuse-large-Bcell-lymphoma.htm. Part of CancerBACUP, the UK's leading cancer information service. . . . Many years ago it was thought that lymphomas could be divided into just two conditions: Hodgkin's disease (named after Thomas Hodgkin, the London doctor who first described it over 100 years ago) and non-Hodgkin's lymphoma (NHL). With the passage of time it has become clear that NHL is not a single illness but includes a number of cancers, which behave very differently. . . . This has a good overview, many useful links, and many more on its Home page.
health.com lymphomas: http://health.com/wynks/LymphomaWYNK2000-MAL/whatyourdoctorcando.html LYMPHOMAS. WHAT YOUR DOCTOR CAN DO FOR YOU. Watchful waiting, Radiation, Chemotherapy, Biological therapy, Bone marrow transplant, Supportive therapy, . . .
People with lymphoma may benefit from some "complementary" alternative therapies, or therapies that are combined with standard treatments. Therapies that might be helpful for lymphoma patients are those that are said to "boost the immune system" or "build the blood." Some of these that have shown promising results are acupuncture, the dietary supplement coenzyme Q10, and polysaccharide K, which is derived from mushrooms.
If you decide to try any alternative therapies, make sure you inform your doctor.
Some of the above might not be relevant to Diffuse large B cell lymphoma.
wellness.net Home Page: http://www.wellness.net Run by the Cancer Recovery Foundation of America, this is an authoritative and user-friendly site that compares conventional, complementary and alternative treatments. Staff counsellors specialize in integrating body, mind and spirit.
Cancer Treatment Trials: http://ecancertrials.com/ 411Cancer.com provides info on latest cancer treatment options. One of its articles includes:
. . . 6-28-01SecondOpinion: http://www.cancerconsultants.com/WeeklyEditorials/6-28-01SecondOpinion-Buckner&Weaver.htm The Importance of a Second Opinion Following a Diagnosis of Cancer. Covers many aspects of this topic.
. . . 411Cancer.com - Providing current information on cancer treatment, drugs, and strategies through clinical trials: http://411cancer.com/web2000/index.html
. . . OncoLink A University of Pennsylvania Cancer Center Resource: http://oncolink.com/ This has a wide range of resources, some of which will be added under Global resources.
. . . cancerTrials A service of the National Cancer Institute: http://cancertrials.nci.nih.gov/
Lymphoma.com What are clinical trials: http://www.lymphoma.com/page13.html . . . Trials are often funded by the National Cancer Institute through its designated cancer centers or other cooperative networks. For additional information from the NCI, visit its Web site at . . .
cancerTrials A service of the National Cancer Institute: http://cancertrials.nci.nih.gov/ or call (800) 4-CANCER.
Lymphoma Education Network: http://www.healthtalk.com/len/index.html Clinal trials -- free video.
LRFA - Open Clinical Trials - All Grades of NHL: http://www.lymphoma.org/pages/nhlallclin.html Lymphoma Research Foundation of America, Los Angeles. Non-Hodgkin's Lymphoma, All-Grades.
. . . Phase I/II Trial of Stem Cell Enrichment and Tumor B-Cell Depletion as Part of an Autologous Transplant.
. . . Phase III Randomized Study of SC-70935 vs G-CSF to Mobilize Stem Cells for Peripheral Blood Stem Cell Transplant with High-Dose Chemotherapy.
. . . Expanded Access Program of Iodine-131 Anti-B1 Antibody (Bexxar) for Chemotherapy Relapsed Low Grade NHL (CP-98-020).
. . . New Radioimaging Trials for Localization of non-Hodgkin's Lymphoma Sites.
. . . 2CDA and Topotecan Study for All Grades Relapsed NHL.
. . . Topotecan and Mitoguazone (MGBG) for Relapsed Non-Hodgkin's.
. . . The First Study of BCL-2 Antisense Therapy.
April 1997. Researchers in Britain recently reported promising results with a new therapy for advanced non-Hodgkin's lymphoma. A clinical trial, reported in the British medical journal, The Lancet, found tumor regression in a small sample of patients with BCL-2 positive relapsed NHL who received treatment with a BLC-2 antisense therapy. The drug, Anticode G3139, deactivates the gene BCL-2, which produces a protein that prevents cells from dying naturally. The defect allows damaged cells to replicated out of control into cancer tumors.
According to The Lancet," all nine patients responded well to treatment and no antisense-related toxic effects occurred apart from local inflammation at the injection site." The study's researchers at the Royal Marsden Hospital believe that the therapy's success may hold hope not only for the treatment of NHL but other cancers as well.
For more coverage of these findings, check out The Lancet vol. 349, number 9059.
. . . NHL Treatment Using Radioimmunotherapy with Stem Cell Transplant.
Centerwatch Clinical Trials Listing Service: http://www.centerwatch.com/index.html You can use this site to find a wealth of information related to clinical trials, such as a listing of more than 41,000 industry -- and government-sponsored clinical trials as well as new drug therapies recently approved by the FDA. Our site is designed to be a resource both for patients interested in participating in clinical trials and for research professionals.
Disease Category Listing (95) Lymphomas: http://www.centerwatch.com/patient/studies/cat95.html Clinical Trials: Lymphomas. This has detailed links by centres in the USA, by state, and the following international sites:
. . . Study Posting (1136) -- Trial #21991, Lymphomas, Calgary, Alberta: http://www.centerwatch.com/patient/studies/stu21991.html Pivotal Phase II Multicenter Study of Vincristine Sulfate Liposomes Injection in Aggressive Non-Hodgkin's Lymphoma that is Refractory to or Relapsed After Second-Line Combination Chemotherapy. Tom Baker Cancer Center Clinical Trials, Calgary, Alberta.
Inclusion Criteria: Patients with histologically-confirmed aggressive de novo or transformed non-Hodgkin's lymphoma, as defined by the REAL/WHO classification. Specifically:
- diffuse large B-cell lymphoma
- primary mediastinal large B-cell lymphoma with sclerosis
- intravascular large B-cell lymphoma
- immunoblastic B-cell lymphoma
- T-cell rich B-cell lymphoma
- anaplastic large B-cell lymphoma
- peripheral T-cell lymphoma, not otherwise specified
- anaplastic large null-/T-cell lymphoma . . .
Exclusion Criteria: Patients known to be HIV positive. . . .
. . . Study Posting (1735) -- Trial #27377, Lymphomas, Toronto, Canada: http://www.centerwatch.com/patient/studies/stu27377.html Oral Mucositis Induced by Radiotherapy and High-dose Chemotherapy (study c). Armand Keating, MD, Research Site, Toronto . . . mucositis (inflammation of the inside of the mouth and throat resulting in mouth sores and a sore throat). . . . An investigational recombinant human growth factor called Keratinocyte Growth Factor (rHuKGF) is being evaluated to determine its protective effect on the mucosal tissue and its ability to reduce the mouth and throat soreness . . .
Dana-Farber-Partners CancerCare Protocol Database: http://cancercare.harvard.edu/cancercare/protocol/protocol.html . . . Dana-Farber/Partners CancerCare Protocol Database. This database is a resource designed for use by physicians and patients. Its purpose is to provide a centralized listing of clinical trials in cancer and hematology that are currently available at the Dana-Farber Cancer Institute (DFCI) and the founding members of Partners HealthCare (PHC): Brigham and Women's Hospital (BWH) and Massachusetts General Hospital (MGH). . . . What is a Clinical Trial? . . .
Cure For Lymphoma Foundation: http://www.cfl.org/resources_factsheet_vaccines.cfm A National Cancer Institute research team, led by Larry Kwak, M.D., Ph.D., has made some exciting progress in the development of a lymphoma vaccine. The experimental therapy combines malignant cancer cells with a patient's own natural defenses to fight the disease. In the interview below, Dr. Kwak shares his findings.
May 2001 - Gleevec is approved by the FDA - it has been effective in curing numerous cancers, including Leukemia and Lymphoma. See the video via link near the bottom of the following page: http://www.lymphomainfo.net/lymphoma.html#.
Lymphoma Information Network - Monoclonal Antibody Therapy Zevalin: http://www.lymphomainfo.net/therapy/immunotherapy/zevalin.html Zevalin is an investigational agent monoclonal antibody for B-cell lymphomas.
Zevalin, ancomprised of the murine (mouse) monoclonal antibody ibritumomab linked to the radioactive isotope Yttrium-90, is one of the first radioimmunotherapies to be tested in humans. Zevalin is currently being evaluated by the U.S. Food and Drug Administration (FDA) and the European Union for the treatment of non-Hodgkin’s B-cell lymphoma. In phase III pivotal trials, the Zevalin regimen produced an 80 percent overall response rate, as measured by standardized criteria for tumor shrinkage, in patients with relapsed or refractory (unresponsive) low-grade follicular or transformed B-cell non-Hodgkin’s lymphoma.
CenterWatch Drugs in Clinical Trials Database: http://www.centerwatch.com/patient/cwpipeline/default.asp The CenterWatch Drugs in Clinical Trials Database is a resource designed to help you, your family, friends and professionals in the research and healthcare communities quickly identify promising and potentially life-saving treatments now being studied in clinical trials. More than 1,800 drugs from Phase II and III are summarized in this database with sometimes including NDA submissions.
See also Centerwatch Clinical Trials Listing Service for a database of 41,000 drugs and clinical trials.
Intron A Approved for New Indication in Canada: http://www.pslgroup.com/dg950819.htm
MONTREAL, Aug. 17 -- The Health Protection Branch has granted approval to Schering Canada for the use of Intron A (Interferon alfa-2b) in non-Hodgkin's Lymphoma as adjuvant treatment of high tumor burden follicular lymphoma. Intron A is the first and only interferon to be approved for use in Canada for any type of non-Hodgkin's lymphoma.
The approval was based in part on the findings of a clinical trial in France, headed by Dr. Bertrand Coiffier, Professor of Medicine, Department of Hematology, Centre Hospitalier Lyon-Sud and co-founder of the multicentre Groupe d'Etude des Lymphomes de l'Adulte (GELA). The 242 patient study was published in The New England Journal of Medicine, November 25, 1993. . . .
Lymphomas are the fourth most common cause of death from cancer for both men and women in Canada. According to Statistics Canada, 7,300 new cases of malignant lymphomas are expected to be reported in 1995. For unexplained reasons, the incidence of lymphomas appears to be increasing each year. Because of a young average age (approximately 32 years for Hodgkin's disease and 42 years for other adult lymphomas), lymphomas account for more years of potential life lost than many of the more common adult cancers.
Of the 7,300 cases of lymphomas reported, approximately 20 - 30% of these will be follicular lymphomas. In Canada, lymphoma is one of five cancers (lung, prostate, kidney, and melanoma) to have an overall increase in both incidence and mortality over the last 10 years.
Developed by Schering-Plough, Intron A is a genetically engineered human alpha interferon produced by recombinant DNA technology. Interferon, a naturally occurring protein in the human body, has been shown to possess anti-cancer and anti-viral activity.
Study Suggests New Treatment For Lymphoma: http://www.aidsinfobbs.org/articles/wallstj/89/293 Wall Street Journal. 9/28/89. Some people with the immune-system cancer known as B-cell lymphoma have been found to have tumor "markers" that react to antibodies custom-made for other patients. The discovery raises hopes that doctors may develop an armory of ready-made biological weapons against the disease. . . . Malignant B-cells carry certain proteins, called "idiotypes," on their surface that are the key to an individual's tumor type,. . . Researchers have used such markers as targets for custom-made monoclonal antibodies to bind and block tumor growth. But such custom "anti-idiotypes" can take a year to develop. Thus they have been unavailable to people with advanced lymphoma . . . But researchers at Stanford University and Idec Pharmaceuticals Corp. of La Jolla, Calif., this week reported a finding that could make such tools accessible to a broader group. In the test tube, up to one-third of lymphoma patients' tumors reacted with customized antibodies developed for other people. Such shared tumor markers were previously found to exist among patients with chronic lymphocytic leukemia.
"What we don't know yet is whether {such antibodies} will have a beneficial effect on patients" other than those for whom they were created . . .
This article is more than ten years old; however, it is still informative as background to the newer sources listed below.
Ralph Moss on Cancer--Expert Guidance for Crucial Decisions: http://www.ralphmoss.com/html/whimp.shtml MEDIA ENDS 1995 CANCER COVERAGE WITH A WIMPER.
On December 30, America's newspaper of record, the New York Times wrapped up its 1995 coverage of cancer with a six-column wide story about a new technique for treating lymphoma (NHL). The technique involves incubating cancer cells with what are called dendritic cells.
"The new, highly experimental technique is a different form of immunotherapy that researchers are trying to develop against several kinds of cancer," Dr. Lawrence Altman, a Times science writer, explained.
It is a well-written story about interesting research. Yet I find something disturbing about the drift of this article. For it is exactly the kind of excited story of a big breakthrough that leads nowhere. . . .
NON-HODGKIN'S LYMPHOMA . . .
OTHER TREATMENTS It also galls me that there are experimental immune treatments, already available, that are studiously ignored by the Times. . . .
The Times writers, whatever their other attributes, generally ignore the contributions of maverick researchers such as Georg Springer and Duncan McCollester -- and we could name hundreds of others! They are always playing up the achievements of academics with drug company contracts in their pockets, yet over and over again these achievements turn out to be hollow, half-baked or impractical. Those who have made lasting contributions to the war on cancer are generally deemed "unfit to print."
Non-Hodgkin's Lymphoma Web Site: http://www.iolinc.net/~sigley/NHL_Web_Site_specials_page.htm Many links, including:
. . . IDEC Pharmaceuticals developes anti-lymphoma antibody to treat B-Cell lymphomas: A series of Press Releases.
. . . Genta, Inc. and Royal Marsden NHS team on Genta G3139 for NHL. , including:
. . . . . . Genta and the Royal Marsden launch world's first trial of antisense therapy for Lymphoma (A press release).
. . . Monoclonal antibodies & Radioisotopes:
. . . Intron A: See Intron A (Interferon alfa-2b).
. . . The role of Genetics in NHL: Several links, including a Primer on genetics
New treatment targets lymphoma: http://www.msu.edu/~mannjam1/dateline.htm By Bob Bazell NBC NEWS Bexxar CORRESPONDENT. . . . Date Nov 98 or 99? low-grade non-Hodgkin’s lymphoma, a cancer of the immune system, which can appear almost anywhere in the body and make it difficult for white blood cells to fight disease. . . .
As much as he wanted to fight,
there were few options. Conventional treatments — including
chemotherapy and radiation — at best bring a remission which
is often temporary and the treatments can make patients very
sick.
But Billow got another choice. His
doctors advised him to enroll in experimental trials for a new medicine called Bexxar that was showing promising results.
Dr. Mark Kaminski says the drug is not a magic bullet for lymphoma, but “it’s getting close.” Kaminski headed the team that developed the new drug at the University of Michigan Cancer Center in Ann Arbor, and co-owns the patent.
“It’s like a homing mechanism,” he said.
“These antibodies are smart; they know exactly where to
go.”
A SEEK-AND-DESTROY MISSION
It is a piece of biotechnological
wizardry. An antibody is attached to radioactive iodine.
Together, they seek out cancer and destroy it. . . .
Patients get the medicine in two separate intravenous injections that in the future could be given in a few hours, on an outpatient basis, he said. . . .
Kaminski said that so far 100 percent of previously untreated
patients see their tumors shrink when given Bexxar,
with 71 percent having a complete remission — a higher rate than conventional
treatment. And since Bexxar seeks
out only cancer cells, not
healthy cells, it does not
cause the usual side effects of chemotherapy and radiation.
Singh has now been in complete remission from her advanced lymphoma for more
than 18 months. She never had chemotherapy or radiation, and said
she never even felt sick.
She said her only side effect from the
treatment was a temporary low blood count, and an underactive
thyroid, which is easily treated with a replacement hormone. .
. .
U-M CCC - Lymphoma Treatment - Dr. Kaminski: http://www.cancer.med.umich.edu/news/kaminsk.htm New Treatment Targets Lymphoma. Nov 1998. Radiolabeled Monoclonal Antibody Therapy for Non-Hodgkin's Lymphoma. A promising form of treatment for non-Hodgkin's lymphoma is being studied by Mark S. Kaminski, M.D., and his colleagues at the University of Michigan Comprehensive Cancer Center and sites around the United States. The treatment involves the use of radiolabeled monoclonal antibodies that home to tumor cells. . . . Much detail of tests.
Coulter Pharmaceutical, Inc. (producers of Bexxar) can be reached at 1-800-823-7003.
New Bulletins2: http://www.drugdigest.org/DD/Articles/Bulletins/NewBulletins2/0,4019,171,00.html New treatment for lymphoma. July 23, 1999.
The US Food and Drug Administration (FDA) has given priority review status to a new medication to treat a type of cancer -- non-Hodgkin's lymphoma. The new medication, which has been given the trade name Bexxar, is being developed in a joint effort by Coulter Pharmaceutical Inc and SmithKline Beecham PLC.
Bexxar could be the first drug of its class to come to market. The drug is a radioimmunotherapy which attaches to a protein found only on the surface of cancer cells. The drug is felt to work via activity within the patient's immune system that will enable the tumor cells to receive a larger dose of cancer treating radiation therapy. The drug may also minimize exposure of radiation to normal tissues.
Bexxar Effective As First-Line Therapy For Non-Hodgkin's Lymphoma: http://www.pslgroup.com/dg/2889a.htm PALO ALTO, Calif. -- May 20, 1997-- Preliminary clinical data presented today on Bexxar radiolabeled monoclonal antibody which is being investigated as a first-line therapy for low-grade non-Hodgkin's lymphoma, revealed that all patients responded to the therapy, with a greater than 50 percent shrinkage of their tumors.
Expanding the Arsenal of Lymphoma Therapies: http://cbshealthwatch.medscape.com/cx/viewarticle/210989_print Review article. . . . New Treatments.
One monoclonal antibody that has been approved by the Food and Drug Administration for the treatment of B-cell non-Hodgkin's lymphoma is called Rituxan. The approval, in 1997, was the first for a new treatment for lymphoma in 10 years. In early studies of Rituxan, about one-half of chemotherapy-resistant patients treated with the agent experienced shrinkage in their lymphoma tumors. In addition to Rituxan, the FDA approved the monoclonal antibody Bexxar in 1999 as a treatment for lymphoma.
Both Rituxan and Bexxar are expected to expand the arsenal of lymphoma treatments. And many medical professionals expect therapy using monoclonal antibodies to become an important part of the treatment of lymphoma in the next several years. Clinical trials are also currently underway to test the effects and explore further uses of Rituxan and Bexxar and to investigate other monoclonal antibodies. . . .
Cytokines are another biological therapy that causes the body to fight cancer itself. . . .
Jenette Restivo is a freelance medical writer.
Reviewer: Beth Israel Deaconess Medical Center. Reviewed for medical accuracy by physicians at Beth Israel Deaconess Medical Center (BIDMC), Harvard Medical School. BIDMC does not endorse any products or services advertised on this Web site.
UI Cancer Center researchers to study new treatment for lymphoma: http://www.uiowa.edu/~ournews/1999/july/0702link.html July 2, 1999.
IOWA CITY, Iowa -- University of Iowa Cancer Center researchers will begin a series of studies to determine the effectiveness of a new treatment for lymphoma. . . . using the body to heal the body.
"We know that our body uses antibodies to fight infection, so researchers have worked hard over the past two to three decades trying to manipulate the immune system to use monoclonal antibodies to fight cancer," said Brian Link, M.D., UI assistant professor of internal medicine. Monoclonal antibodies are protein components of the immune system designed to attack and destroy tumors expressing specific molecules.
In 1997 the Food and Drug Administration approved the use of Rituxan, the first monoclonal antibody seen as effective in treating certain types of cancer, specifically lymphoma. Experiments with Rituxan were done at the UI and other centers. Since that time, two monoclonal antibodies have been approved for different types of cancer, and researchers continue to look for ways to expand on these early successes.
The experimental program currently underway involves using a monoclonal antibody called Hu1D10. This specific monoclonal antibody is of interest because previous research has noted its ability to attack a specific molecule on lymphoma cells. . . .
In 1990 Roger Gingrich, M.D., UI professor of internal medicine, created a new antibody called 1D10. Developed from laboratory mice, 1D10 targeted a previously unknown molecule on lymphoma cells. The significance of this discovery led to further investigation of 1D10 . . .
"Rituxan targets a molecule called CD20," Link said, "We hypothesized that there are other molecules on the lymphoma cell that, if targeted, might either add to the efficacy seen when CD20 is targeted or might be more effective than targeting CD20."
. . . the next step. The researchers will conduct a series of studies . . . that will test the effectiveness of the Hu1D10 antibody in lymphoma patients.
LRFA - Lymphoma Newsline Archives: http://www.lymphoma.org/pages/newsline/025.html Lymphoma Research Foundation of America. Article #025: Pivotal Clinical Trial of First Monoclonal Antibody for Cancer Published in Journal of Clinical Oncology.
SAN DIEGO and SOUTH SAN FRANCISCO, Calif.--(BW HealthWire) -- Aug. 17, 1998 -- Projected Median Time to Progression of Disease is 13.0 Months for Intent-to-Treat Patients; Nearly 70 Percent of Responders Still in Remission.
IDEC Pharmaceuticals Corporation (NASDAQ:IDPH) and Genentech, Inc. (NYSE:GNE) today announced that study results on projected median time to progression of disease for Rituxan™ (Rituximab) were published in the August 1998 issue of the Journal of Clinical Oncology. Final study data will be re-analyzed after all the patients have relapsed. Rituxan is indicated for the treatment of relapsed or refractory low-grade or follicular, CD20-positive, B-cell non-Hodgkin's lymphoma.
In November 1997, Rituxan was approved for marketing by the U.S. Food and Drug Administration (FDA) as a single agent for the treatment of relapsed or refractory low-grade or follicular, CD20-positive, B-cell non-Hodgkin's lymphoma. It is the first new therapy in 10 years for non-Hodgkin's lymphoma and the first monoclonal antibody (MAb) licensed for the treatment of cancer in the United States.
In the pivotal trial conducted at 31 U.S. sites, Rituxan, when used alone, showed a 48 percent overall response rate in 166 intent-to-treat patients. Ten of these were complete responses (6%) and 70 were partial responses (42%) as measured by a blinded independent Response Evaluation Committee. Among those who did not achieve a complete response or partial response, the majority (56 of 75) nonetheless had a net decrease of measurable disease (mean decrease, 32%). . . .
Rituxan is administered in four infusions over a 22-day period in an outpatient setting often in a physician's office. Special handling of the therapy or patient is not required. . . .
There are approximately 250,000 patients in the United States with B-cell non-Hodgkin's lymphomas, which are malignancies of the body's antibody-producing immune system cells. Of these patients, about half are diagnosed with low-grade or follicular lymphoma and the other 50 percent with intermediate-grade to high-grade lymphoma. Currently, standard treatment consists of chemotherapy and/or radiotherapy. . . .
For full prescribing information on Rituxan, please call (800) 821-8590.
NHLMay00-4: http://www.cancerconsultants.com/TreatmentNewsUpdates/NHLNews/NHLMay00-4.htm Rituxan™ May Be Active against Primary Central Nervous System Lymphoma. Primary central nervous system lymphoma (PCNSL), a type of cancer affecting the brain, eyes, and leptomeninges, is often treated with high-dose methotrexate or other chemotherapy drug. However, some persons have a recurrence (return) of their disease after this initial treatment. At the American Society of Clinical Oncology annual meeting, New York researchers presented the first report on the use of Rituxan™ as a single therapy for recurrent PCNSL. . . .
Two sources of information on ongoing clinical trials include clinical trials listing services provided by the National Cancer Institute (cancertrials.nci.nih.gov) and eCancerTrials.com. eCancerTrials.com also performs personalized clinical trial searches on behalf of patients. (Proceedings of the American Society of Clinical Oncology Thirty-Sixth Annual Meeting, Volume 19, Abstract 642, p 166a, 2000).
I doubt that this article is relevant; however, the above two links might be of use.
NHLMay00-9: http://www.cancerconsultants.com/TreatmentNewsUpdates/NHLNews/NHLMay00-9.htm Rituxan Appears Promising for Persons who Relapse after Undergoing Stem Cell Transplant for Non-Hodgkin's Lymphoma.
Rituxan™ was recently approved by the U.S. Food and Drug Administration (FDA) for the treatment of follicular or low-grade B-cell non-Hodgkin’s lymphoma that is resistant to or that relapses on the standard first-line therapies. New research also shows that Rituxan may benefit persons with non-Hodgkin’s lymphoma who have suffered a relapse after undergoing high-dose therapy and an autologous stem cell transplantation, according to a presentation by researchers from San Diego at the May 2000 American Society of Clinical Oncology meeting. . . .
Radiation Therapy News: http://www.asrt.org/profession_glance/radiation_therapy_index.htm Radiation Therapy May Benefit Patients With Stage III Non-Hodgkin's Lymphoma. 3/2/01.
New research has raised the possibility that patients with incurable stage III follicular non-Hodgkin's lymphoma and a limited tumor burden could benefit from radiation therapy. The research appeared in the January 2001 issue of The International Journal of Radiation Oncology Biology and Physics.
The retrospective study of 66 patients with "limited disease" treated at Stanford University from 1963 to 1982 found that those treated with total nodal irradiation had a median overall survival of nine and a half years. Significantly, none of the patients in the study died of lymphoma and only one patient relapsed during the 20-year follow-up period.
Because Stage III follicular lymphoma is considered incurable with current therapies, the standard management approach is one of "watchful waiting" . . .
BMT SUPPORT ONLINE=== BMT Links (P, S, T): http://www.bmtsupport.org/links/linkspst.htm Medications: Bexxar, Rituximab, . . . Many links.
Mayo Clinic - Laboratory Study Shows Measles Vaccine May Offer Novel Approach for Treating Lymphoma: http://www.mayo.edu/comm/mcr/news/news_1631.html Mayo Clinic Rochester News. June 7, 2001.
OncoLink NCI CancerLit Search THERAPY OF NON-HODGKIN'S LYMPHOMA - March 1996: http://cancer.med.upenn.edu/cancernet/96/mar/703371.html University of Pennsylvania Cancer Center. Has many links, including:
. . . TI - Radioimmunotherapy of B-cell lymphomas with iodine-131-labeled LL2 monoclonal antibody (Meeting abstract). SO - J Immunother 1994;16(2):160 AD - Roswell Park Cancer Inst., Buffalo, NY. http://cancer.med.upenn.edu/cancernet/96/mar/703371.html#5
. . . TI - Non-myeloablative radioimmunotherapy with 131-I-anti-B1 for refractory B-cell lymphoma: Phase I results (Meeting abstract). http://cancer.med.upenn.edu/cancernet/96/mar/703371.html#11 The CD20 cell-surface antigen expressed by greater than 95% of B-cell lymphomas and recognized by the mouse monoclonal antibody anti-B1 is an attractive target for radioimmunotherapy (RIT) of lymphoma. We entered 36 patients (pts) who had failed chemotherapy onto a Phase I protocol designed to evaluate the tumor targeting and the maximum tolerated radiation dose (MTD) not requiring bone marrow transplant (BMT) support of anti-B1 labeled with 131-I (131-I-anti-B1). . . . We conclude that non-myeloablative RIT with 131-I-anti-B1 is an effective, minimally toxic, new therapy for lymphoma. Phase II/III studies are planned.
Someone You Should Know: http://www.bmtnews.org/newsletters/issue16/someone.html Blood and Marrow Transplant example. .. . . " . . . If people know in advance that the whole family needs moral support, not just the patient, they'll be happy to respond."
I will be adding more . . .
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You can e-mail me at waynerp@sympatico.ca.