Non-Hodgkin's Lymphoma and Anticoagulation

Hello again from New Orleans and the 51st annual meeting of the American Society of Hematology! The weather has been rainy and cold outside, but in the presentation halls of the convention center the data being shared is Hot (and sometimes hotly debated!)

I attended the Oral Scientific Session for Non-Hodgkin' Lymphoma (NHL). Two of the presentations are worth discussing and may change therapy for our patients diagnosed with different subtypes of NHL.

The first discussion was in regards to a study comparing Bendamustine in combination with Rituxan to the standard chemotherapy of CHOP + Rituxan in patients with Follicular NHL. The results strongly favored Bendamustine. The combination of Bendamustine and Rituxan led to improvement in the time until lymphoma returned by approximately 20 months! In addition there was less side effects than to the standard chemotherapy including less infections and no hair loss! Because this is only one study from Germany, many investigator and physician scientists feel that this study needs to be repeated more broadly to verify the benefit. WVMC will hopefully be participating in this important study. I met with a representative from Cephalon pharmaceutical company to begin the process of making WVMC one of the North American sites for this large international study.

The next discussion was on a very aggressive subtype of NHL called Mantle Cell NHL. The study compared three chemotherapy regimens....two aggressive regimens (one of which includes a stem cell transplant) and one standard regimen (CHOP+Rituxan). The two aggressive regimens were equivalent and both better than CHOP+R in leading to longer life expectancies for patients with this lymphoma.

Finally, the lead presentation at the Plenary Scientific Session was on the use of a new oral medication for anticoagulation (or blood thinning) in patients with a blood clot in their leg or lungs. The standard medication used for 50 years has been warfarin. Warfarin is difficult for patients to use because you have to adjust your diet and have laboratory monitoring every 2 weeks (if not more). The new medication is called dabigatran. It does not require monitoring and can be taken with or without food. The study showed it had the same effect in reducing recurrent blood clots, and with less of the side effect of bleeding. This may be a major breakthrough for our patients that require anticoagulation for various reasons.

That is all for now. I look forward to heading back to Wenatchee tomorrow and getting back in the clinic with all my wonderful patients.

Best Regards,
Mitch

Comments

[Kit Jors]

Dr Garrison what do you think of the this drug being applied for cell kill with Bendamustine and Rituxan ? Recently I have been in contact with Dr. Daphne Friedman, a physician at Duke University who has a special interest in CLL. She is also the principle investigator for the perifosine clinical trial for CLL patients. She pointed me to their website dedicated to CLL and it has a lot more information on their perifosine clinical trial.http://updates.clltopics.org/2298-perifosine-a-new-drug-on-the-horizon