Treatment Preferences in R/R Follicular Lymphoma (ASH)

I guess I'm still not finished with commentary from the ASH conference last month.

The Oncology Learning Network posted a video of Dr. Krish Patel of the Sarah Cannon Research Institute, in Nashville, Tennessee. He discusses some research he presented at ASH this year. The presentation was called "Diverse preferences for treatment options in relapsed/refractory (R/R) follicular lymphoma (FL): Survey results from patients in the United States (US)."

I'm afraid I can no longer read or link to ASH abstracts from this year. That might be a temporary thing. If I can get a link to this presentation sometime soon, I'll post it here. So I'm getting my information from what Dr. Patel says in the video (there is a transcript in case anyne would like to read it or translate it).

I'm a little surprised that I didn't see this abstract when I was first searching. It's a interesting topic, and one that I was involved in for a presentation at ASCO last spring. In our ASCO presentation, we reported on research we did through the Follicular Lymphoma Foundation. That research found, in general, a kind of "let's get this over with" attitude among FL patients. Patients wanted longer Progression Free Survival, so there would be a longer time between treatment. We preferred oral tablets over infusions. We wanted limited duration for treatments, rather than something we'd need to do for the rest of our lives. And we wanted as little travel as possible, preferring to stay closer to home.

The ASH research found some similar trends. It reported on a survey of 125 FL patients with relapsed or refractory disease. As I said, the results were similar -- patients wanted less frequent treatment; a definite start and finish to the course of treatment, rather than something ongoing; they wanted to be as close to home as possible; and they wanted as little monitoring as possible. 

What I found especially interesting was the conclusion that Dr. Patel reached.

The research was prompted by the large number of treatments that have been approved in recent years. As patients, we really do have a lot of choices (at least in theory). But there has been very little direct comparison between those treatments. There might be studies done after the fact, where a researcher looks at the results of clinical trials between, say, CAR-T and bispecifics. But there are very few direct comparisons, where two approved treatments are studied in a randomized two-arm trial. There is little incentive to do that if they have already been approved. The money and time needed could be spent on clinical trials to gain approval for a new treatment.

But, as Dr. Patel says, since there are so few direct comparisons between treatments, and so much difficulty in saying one is better than another, or more appropriate than another, then doctors should be paying more attention to patient preferences. It's kind of an admission that perhaps patient preferences are considered nearly enough.

Of course, it's more complicated than just asking a patient what they want. Most patients probably don't know, or don't want the burden of having to choose. I know I would like some input into treatment decisions. But I also think about people that I love who have been treated for different cancers, and I see how overwhelmed they are at the thought of making a decision like that. Better to just leave it up to the experts. 

And, of course, patient preference assumes there is a choice to begin with. But plenty of patients have no choice -- their insurance company, or national health system chooses for them, or their financial situation dictates their choices, or their geographical circumstances limit what they can do. In an ideal world, a patient would have all of the information they need to make the right choice, and unlimited resources to make that choice happen. But we don't live in an ideal world.

The fact that this appears on a site called Oncology Learning Network might say something about who this is meant for. If patients have limited choices, then it's up to doctors to make them fully aware of what those choices are. And that's who this is aimed at. If oncologists know that, in general, these kinds of Quality of Life issues matter to patients, then they will begin to incorporate them into their conversations with patients. 

And, looking at the bigger picture, maybe researchers who develop treatments, and companies that make them, will build those preferences into their processes, figuring out ways from the start to make treatments easier on patients. I like to think they do this already, but we also see that something like the bispecific Mosunetuzumab was approved first as an intravenous treatment, and then as subcutaneous. So it's certainly possible to make a treatment in a form that is easier on the patient.

The lesson for us as patients is to remember that we do have preferences. That's especially true of those of us who have, or may have, relapsed/refractory disease. We have the benefit of experience and time. Experience of already having had at least one treatment, and knowing what we liked and didn't like about the experience. And time to think about what we'd like to be different next time (if we need treatment again).

It's all about being aware and being clear about what you want. Not every cancer patient thinks this way, and that's fine. But if you're reading this, chances are pretty good that being informed is something that you care about.

 

18 Years

Today is my diagnosiversary. I was diagnosed with Follicular Lymphoma 18 years ago today.

It's also the 16th anniversary of my first Rituxan treatment. I haven't needed any treatment since.  

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If you've been reading for a while, you know that I like to take this day to do some reflecting. 18 years is a long time. I've seen a lot. I remember when I was diagnosed in 2008, the accepted median survival for FL was 8-10 years. It's about double that now. So I'm not really all that special. I hope all of you who are fairly newly diagnosed will keep that in mind. If you're like me, you'll have a long, happy life ahead of you. It's hard to see that far ahead sometimes.

A couple of months ago, I was fortunate to be part of a Zoom call with about 15 other FL patients. That kind of gathering is always a special time, because you realize (or you are reminded) that you really aren't all that special -- your experiences and feelings are shared by many others. And that's a good thing. Hard things are easier when you understand that other people have gone through the same thing and come out the other side. I always feel better after a meeting like that. 

One of the other participants in that meeting said something that I have been thinking about for 18 years. We were talking about the emotional side of having FL and she said something like, "Everyone says cancer changes you, and it does. But I'm trying to figure out what it changed me into. Who am I supposed to be?"

That question -- who am I supposed to be? --always comes to me as a song, for some reason. The third verse from the song "Rainbow Connection," sung most famously by Kermit the Frog.    

Have you been half-asleep, and have you heard voices? I've heard them calling my name. 

Is this the sweet sound that calls the young sailors? The voice might be one and the same.

I've heard it too many times to ignore it. It's something that I'm supposed to be. 

That's the line that always gets me. What am I supposed to be? If you know your Greek mythology, you know the sweet sound calling to sailors is a Siren, and things don't work out too well for the sailors. There's always that bit of doubt about who I am, who I'm becoming, what I'm supposed to be doing. 

So here's the wisdom that I want to share on my diagnosiversary -- some ways to think about who we are and who we've become. I don't really have an answer to the question. But I have some ways to think about it.

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A couple of months ago, I shared a link here in the blog to an essay that I wrote called "Restoration." It was published in Intima: A Journal of Narrative Medicine. If you're not familiar with the term "narrative medicine," it's the idea that writing about health issues can be a kind of medicine in itself. Narrative medicine was first applied to doctors, who could use writing to work through some of the emotions that come from dealing with patients, especially when all of a doctor's best efforts can't help someone. The idea of narrative medicine is broader now, and applies to all kind of healthcare professionals, and patients, and survivors, and caregivers. Writing about a difficult thing can be a great way to deal with it. (I know -- I've been doing it for 18 years.)

In the essay, I wrote about how the process of repairing and restoring a tea wagon helped me think more about that question of who I'm supposed to be. I didn't put it that way exactly in the essay, but it's really the point of it all.

I enjoy restoring furniture. It's very satisfying to take something that seems useless and turn it into something useful. If you're curious, this is the tea wagon that I restored and wrote about:

   

I was proud of the tea wagon, and I was even more proud of the essay. It took me months to write, until I finally found the words that reflected what I was feeling. In want to talk more about that, because it gets at that question of who we're supposed to be.

I watch a lot of furniture restoration videos. I have a bunch of favorite restorers. They do lots of different things with the furniture they work with. Some of them are professionals who make their living restoring furniture. These are true restorations -- they work to bring them back to something close to their original state. These folks are amazing. They are hired by antique dealers and museums to work on valuable pieces and keep them from losing their value.

Other folks recognize that aren't doing actual restorations. They might change the color of the piece or change the handles on the drawers to make a 50 year old dresser look more contemporary. They might take broken piece of furniture that they bought for $20 and fix them up and sell them for $200. They're not trying to bring something back to its original state. They're making it something new. It's not restoration, it's renovation -- literally "making something new." 

My tea wagon is not a restoration. I used different materials than were used on the original, like gel stain and polyurethane instead of tinted lacquer. The small wheels on the back were not original, either -- they were put there by my father-in-law, who made his own attempt at renovation may years ago. 

And as I said in the Intima essay, I'm not sure there really is such a thing as true renovation. We can't really bring something back to the way it was in the past, not after it's been through something that damaged it. We can pretend it's the old thing. It might look like the old thing. But it's not the old thing. It has to be something new.

And that's one way of thinking about who we've become. 

Cancer changes us. There's no getting around that. We can try to restore ourselves, try to get back to who were. But it won't ever be the same. We've changed physically, emotionally, mentally, spiritually. We're someone else.

That doesn't mean we shouldn't try to go back to who we were. We're not likely to get there. And to be honest, even if I stayed perfectly healthy over the last 18 years, I couldn't really go back to who I was at 40. Things change even without a cancer diagnosis to help the process. But maybe the attempt at restoration results in good things. Maybe we eat better and exercise more and connect with people and work to change the world and try to do all of the things that we did before cancer. Even if we don't get there, maybe the attempt at restoration is a good thing. 

That's one way to figure out who you're supposed to be.

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Another way is renovation -- becoming someone new, or at least accepting that you are someone new. 

One of my more recent renovation projects was an old mahogany end table that I picked out of someone's trash. It was in rough shape. It's probably 100 years old. It had a really beautiful leather top. At least the top was beautiful at one time. When I found it, the leather was stained and torn and someone had tried to glue it back down and that just created more problems. There was no way to save the leather top. I looked into getting a new leather top, but it would have cost about $100 to get one made, and that was way too much for me to pay. (Remember, I'm the kind of person who picks things out of other people's trash.)

I took about 2 years for me to figure out what to do with it. I finally decided to fix the top by adding a kind of patchwork of veneers -- very thin pieces of wood. Lots of the veneers I used were from other pieces of furniture that I found in people's trash. I cut them to fit and glued them in place -- mahogany, walnut, maple, oak, and cherry. This is what it looked like when I was finished:

  

I like it. It's definitely "making it something new." It's a lot different from the 100 year old leather top, and (I think) a little bit fun and funky. There was no way to restore it, to bring it back to what it used to be. But I could make it into something new and different, so I did. It won't end up in a museum, but it could end up in someone's living room.

To me, this table is a second way of figuring out who we're supposed to be. 

It was damaged, taken from the trash. It was fixed with more pieces taken from the trash. I'm using this picture deliberately, because you can't see the flaws from this angle and this distance. And there are definitely flaws. I'm not happy with that back row of veneers, and a couple of them cracked, and one is a little wavy instead of flat. And that's not even getting into the rest of the piece and the bad repairs I made (and hid) in a couple of places.

So many of us hide our damage. And that's an OK way to be, too. People ask "How are you?" and we say "Good. I'm good. I'm fine." Because it's easier to say that and to smile than to detail all of the damage. The neuropathy. The irregular heart beat. The pain in the hip. It's easier to cut some veneers and glue them in place and smile and say everything is fine and hope no one notices. 

That's another way of being who we're supposed to be. We get through the day. Even that's a victory sometimes.

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There's another way of being. I'd love to say I have a piece of furniture that I worked on to demonstrate this, but I don't.

There is an art in Japan called Kintsugi, which means "joining with gold." When a ceramic piece is broken, the parts are joined back together with gold. 

It looks something like this:

 

The idea is that we don't hide the damage -- we celebrate it. We recognize that there is beauty in imperfection, and that repairs are a sign of resilience, not weakness.

And that's another way of being who we're supposed to be.

Recognize the imperfections, and then go beyond that and celebrate them.

I'll put it another way, for those of you who enjoyed the movie KPop Demon Hunters (or who have kids or grandkids who enjoyed it). The song "This Is What It Sounds Like" has the excellent lyrics:

I broke into a million pieces, and I can't go back
But now I'm seeing all the beauty in the broken glass
The scars are part of me, darkness and harmony
My voice without the lies, this is what it sounds like

Why did I cover up the colors stuck inside my head?
I should've let the jagged edges meet the light instead

Beauty in imperfection. Let it shine.

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I'm certainly not the first person to compare being a cancer patient with Kintsugi. 

I'm also not saying that celebrating our flaws is the best way to be who we are.

I suspect that most of us have been all three -- a tea wagon, an end table, a ceramic bowl. We've been restored, renovated, and celebrated. We've tried lots of different ways to be who we are supposed to be.

I suspect most of us are all of those things at the same time. One day we wish things used to be the way they were. The next day, we smile and make the best of the bad things. The next day, we celebrate the flaws and decide we'll live with them openly. A week later, we're back to wishing things were the way they used to be.

And that's OK.

I said I don't have an answer to who we're supposed to be, because I'm not sure there is an answer.

It's not a fixed state. It's not a thing. It's a process.

The important thing is, we keep looking, we keep discovering, and we keep trying. We keep moving forward, even if it's just a little at a time.

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I am so very grateful to all of you who read the blog, and who comment, and who write me emails, and who share posts, and who just remind me to keep writing and to keep trying to figure out who I'm supposed to be.

I'm looking forward to sharing more with you this year.

Thank you all. Stay well.  

 

FLF Webinar on Bad Days

OK, I messed up. My last post, from last Wednesday, was supposed to be published today. But I wasn't paying attention and I just hit the "post" button instead of setting a future date, so that left me with too much time between posts. I've been spending a few days with some family that I don't get to see very often, so I thought I'd write a post and have it all set to go so I wouldn't need to worry about it and I could focus on my nieces and nephews and great-nephews. So much for that plan.

So you're getting a kind of bonus post today. 

I want to let you know that the Follicular Lymphoma Foundation is doing a webinar on January 28 called "Living with FL: Coping with the Down Days." It is happening live at 2.00pm GMT (6.00am PT; 10.00pm UTC; 9.00am ET​). It should be excellent. 

The webinar will be led by Dr. Mitchell Smith, the FLF Chief Medical Officer, who always does a fantastic job with these webinars, asking the right questions and leading the discussion in productive ways. The FLF always includes a medical expert, and this time it will be Surabhi Chaturvedi, an integrative psychotherapist with a background in clinical psychology. She works specifically with patients with blood cancers. And there's always a patient expert, too, who talks about their own experience. This time, it's Dr Claire Hucker, who is a GP with the NHS. In addition to being a medical doctor, she was diagmosed with FL in 2019, when she was in her 40's. She received O-CHOP as a treatment, which was successful. Dr. Hucker should provide  a very interesting perspective on this.

You can read more about the webinar and register at this link. If you can't make it, a recording of the webinar will be posted online on the FLF website, where you can find all of their webinars.

I expect the webinar to have lots of good practical advice for dealing with the bad days that we all have sometimes.

A couple of other resources for you:

The title of the webinar resonates with me. There's a bit of advice that I give other cancer patients (when they ask me for advice) -- it's OK to have a bad day. Sometimes we feel the pressure to be positive, especially because lots of well-meaning tell us that we "need to stay positive." That's usually good advice, but not always. You can click here to read more about what I have to say about having a bad day.   

Another resource is a recent episode of the Follicular Lymphoma Community Podcast called "FL and the Holidays." I know we're past "the holidays" now that's the middle of January, but the episode is kind of timeless. When we have "bad days," it's often for the same kinds of reasons that the holidays can get us down -- we're exhausted, we're overwhelmed, we've set expectations that we can't live up to. All of those things can be highlighted during the busy holiday season, but they happen at all times of the year. So if you need some advice and you can't wait for January 28, watch the FL Community Podcast and get great advice from some other FL patients. (Just ignore their festive hats ad sweaters,)

I hope you enjoy your "bonus post" and take advantage of the good advice I have posted.

Even better -- I hope you don't need it.

Take care, The diagnosiversary post is coming up next.

 

More ASH Reviews

 I'm going through all of the links I have saved from the last month or so, and I have a few more related to ASH that are worth sharing, Not necessarily any new information, but at the very least, it's confirmation that some good things were presented at the conference last month.

The website Medscape published two video reviews of the conference.  The first is called "ASH 2025: The Clinical Impact of New Therapies and Long-Term Outcomes in Follicular Lymphoma." It features Dr. Kami Maddocks of The Ohio State University. She discusses some of the more important presentations at ASH, and focuses on clinical impacts -- how the new information might directly affect current patients.

Of course, she focuses on the data related to Epcoritamab + R-Squared, which she says is "going to change practice." In other words, we're likely to see it recommended for patients who have Relapsed or Refractory disease who are need of a treatment option. She also mentions Tafasitamab plus R-Squared, and the issues related to sequencing CD19-directed therapies. That is, patients who received Tafasitamab kept the CD19 protein on their cancer cells, meaning a teatment like CAR-T, which targets CD19, should be used after Tafasitamab, not before. (The presentation that discussed this was also on The Leonard List for this year.)

Dr. Maddocks also mentions the research that looked at long-term (20 year) follow-ups of FL patients, which found that 40% of patients who received immunochemotherapy (like R-CHOP or R-Bendamustine) were still disease-free after 15 years. And about 20% of patients who watched and waited continue to do so for 15 years. Finally, this study also showed that the risk of Transformation to a more aggressive Lymphoma decreases after 10 years. Dr. Maddocks says this is all important information when oncologists counsel FL patients about long-term outcomes. (This all sounds very familiar to me, but I can't find a link for this presentation, unfortunately, and the video doesn't include it. But it's great news -- I love a good long-term follow-up.) Finally, she discussed the research about GLP-1s and indolent Lymphomas including FL, something else that was on The Leonard List. (You might remember that I was hesitant to discuss that one. Dr. Maddocks thinks it looks very interesting, but there needs to be more data collected about it.)

So lots of good information, with the focus on how it all plays out right now in the doctor's office.

The second video review from Medscape is called "New Options in Follicular Lymphoma From ASH 2025," and features Dr. Michael R. Bishop from the University of Chicago. As the title suggests, Dr. Bishop is interested in some of the new treatments that were presented at ASH. Of course, he starts with Epcoritamab (because that's what everyone is excited about -- he calls it "The Big News" from the conference. He also mentions the presentation on Epcoritamab + R-Squared in untreated FL. He wants to see long-term follow-up to make sure the excellent responses will last, and he points out that it was a very small trial.

 Dr. Bishop also looks at a presentation on the CAR-T known as Liso-cel. In this research, Liso-cel was given to FL patients who were "heavily pre-treated" -- who had already received at least two other treatments. The results were great -- a 97% Overall Response Rate, including a 94% Complete Response. After 36 months, 75% of patients had not yet needed another treatment.  (Sorry -- I don't have a link for this one, either, but it's no surprise that a CAR-T was effective, though Dr. Bishop did point out that there were some secondary cancers in some patients.)

He also discussed another of The Leonard List presentations, this one looking at the Gallium Trial, showing that mutations in EZH2 and CREBBP could help predict success with Bendamustine. This research is important in showing how biomarkers can help guide treatment.

So, again, not much that hasn't been covered already, but I do think it's important to show that multiple Lymphoma experts see certain research as moving us forward. It's hard to see that when just reading abstracts. I enjoy hearing experts tell me what excited them after the conference is over. If you've ever been to a professional conference of any kind, there's a special kind of magic that you feel afterwards, when you have all of this new knowledge that's really exciting. These videos capture just a little bit of that.

More soon. 

 

A Few Approvals

Hello all, and welcome to 2026.

It's been a week since I have posted. I usually try to get something up a little sooner than that. But I started the new year with some computer problems, and it's taken a few days to get things fixed. Thankfully, I'm back to writing. I supposed I could have written a blog post on my phone, but honestly, I'm just too old for that. The buttons are too small, the words are too small, and my patience is too small. I wear progressive lenses for a reason. 

On a related note, Spotify gave me my "Listening Age." If you are unfamiliar, the music steaming service Spotify ends the year by giving you some data about your listening -- the songs or artists you listened to most -- that kind of thing. But they also give you a "Listening Age," a measurement of how old the music is that you listen to. So if you listen to a lot of contemporary music, you'll have a young Listening Age. My Listening Age is 69. I'm not only too old to write with my phone, I'm also too old to listen to anything that wasn't played at my high school prom.

So, just to sum up: 

My biological age is 58.

My Listening Age is 69.

My Lymph Node Age is about 93.

Just so you know what you're dealing with as we enter the new year.

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Unfortunately, I also have a hard time reading on my phone, so I'm behind on Lymphoma news to share with you.

So I'll pass along some of the approval news that has happened in the last few weeks. I haven't been able to share it because I have been focused on ASH.

The big Follicular Lymphoma approval news has been the FDA approval of subcutaneous Mosunetuzumab.  Mosunetuzumab was the first bispecific approved for FL (though Epcoritamab has been in the news a lot more lately). A quick reminder -- bispecifics work by attaching themselves to cancerous B cells, and then also to T cells, which are immune cells that can eliminate the cancer cells. Up until now, Mosunetuzumab has been administered intravenously, through a vein in the arm, over a period of 2 to 4 hours. With the subcutaneous injection, that time is reduced to about 1 minute. A clinical trial showed that the subcutaneous version was as effective and as safe as the IV version. This is, if nothing else, a Quality of Life issue, with less time spent in a hospital or clinic, and more time doing other things. Ideally, this will also bring the cost down. 

In non-USA approval news, the European Union approved Minjuvi (Tafasitamab) plus R-Squared (Revlimid/Lenalidomide and Rituxin) for patients with Relapsed or Refractory Follicular Lymphoma. I wrote about this in November, when it had been given it's almost-approval, but now it's official.

Also, Japan's Japan's Ministry of Health, Labour and Welfare approved the same Tafasitamab for the same population. I briefly mentioned both of these approvals in my "predictions" post, but I thought they deserved a little bit more attention than I gave them then.

There are a few more interesting FL-related articles that I have seen fromm the last few weeks. My old eyes will have an easier time reading them, and my old fingers will have an easier time writing about them, so look for them soon. And of course, look for my diagnosiversary post next week. I'll have some things to say.

 

How Were My 2024 Predictions?

This will be my last post for 2025, so I want to revisit my last post from 2024, called "Year-End Predictions." Just for fun, I made three predictions about Follicular Lymphoma for 2025.

I'm guessing a lot of you saw the calendar turn to December a few weeks ago and thought, "I wonder how Lympho Bob's year-end predictions went? I've been dying to know if he was right, because he's always so right about everything!"  Well, here we go. Your wish is about to come true.

My first prediction was "Tafasitamab won't be the 'game-changer' that the headlines predict it will." I was right about this.

At last year's (2024) ASH conference, there was a lot of excitement about Tafasitamab (also known as Monjuvi). Tafasitamab is a monoconal antibody, and the results of a stage 3 clinical trial were presented at ASH, where Tafasitamab was combined with R-Squared (Rituxan and Lenalidomide).  I had written about it a few times after ASH. There were lots of commentaries that talked about how great the combination was, and how it would most likely mean Tafasitamab + R-Squared would become the default treatment for Relapsed/Refractory Follicular Lymphoma. That hasn't happened. As I wrote a year ago, it takes a lot to change an oncologist's habits, and unless there is a huge change in survival statistics, there will probably be some change, but not a lot of change. The "game-changer" headlines are often clickbait, getting people like me and the rest of you Cancer Nerds all excited and reading their articles. It seems like there is always some new great treatment that will change things for us. To be sure, treatments are getting better over time (the difference in the choices I had when I was diagnosed about 18 years ago, and those available now, is incredible.) But as I get older, I get more suspicious of news articles that are a little too excited about these things. Tafasitamab may end up being an important part of our treatment choices, but it isn't yet. It was approved by the EU a week ago, and by the Japanese health ministry about the same time.

My second prediction was "Epcoritamab will cause some concerns." Epcoritamab was another treatment that caused some excitement at the 2024 ASH conference. But it also caused some controversy. The effectiveness numbers were great, but the safety raised some questions. There were a few more deaths than were expected, but they were explained by the fact that the trial took place during the Covid pandemic, when some of the trial participants had lowered immunity. As I said in the post, "my gut tells me those concerns haven't been completely answered." Well, as you know if you've been reading lately, Epcoritamab was this year's darling at ASH, and the "game changer" language for Tafasitamab from last year was applied to Epcoritamab for this year. So I'm going to say I was wrong about this one. There were no new safety issues in the year that followed, and Epcoritamab might well be the great treatment that the headlines say it will be. I sure hope so -- the numbers are fantastic. But time will tell.

My third prediction was "There won't be any major changes to the FDA approval process." I'm thinking I'm right about this one, too. Last year, there was talk that the FDA might cut back on surrogate endpoints and focus more on Overall Survival. In other words, they would ask for more long-term data before making decisions, That didn't happen, but there was plenty of controversy at the FDA anyway. I won't get into it. If you live in the U.S. and you follow health news, then you know. There has been a change in leadership, some instability in key positions, and controversies in many areas of pubic health. I was hoping to find a link to an objective source that described the year that the FDA had, but I couldn't find one. I will say, despite the controversies, it doesn't seem to me that the oncology world was effected negatively by it. FL treatments were approved, and people remain excited. The approval process has been largely the same as it was before. We'll stay hopeful that it stays that way, and if it does change, it will be change for the good.

There are a couple of lessons here.

First, I'll say what I said last year when I made the predictions -- remember that I'm not an oncologist or a cancer biologist. When it comes to cancer advice, the best person to talk to is your own oncologist. It's fun to make predictions, but I'd never make a prediction that I thought would affect an individual's life. I wouldn't want that responsibility -- that's not fun. Sure, I got two right, but the one I got wrong, I got really wrong. If your oncologist is a Lymphoma specialist, ask them what gets them excited about Lymphoma research these days. Then watch their eyes get big and their voice get a little louder from excitement. That's the real fun.

The other lesson is a reminder that one year is not a lot of time when it comes to cancer research. We move forward, but in small steps -- rarely in giant leaps. And we don't know for a while just how big a leap it is. Best to enjoy the small victories when we get them, and hope they turn into something big.

I hope your 2025 finishes up wonderfully, and your 2026 brings you good health and happy times.

I'll be back next year. Still lots of small victories to write about.

Take care.

Peace

I want to wish a Merry Christmas to all of you who celebrate. 

And whether or not you celebrate, I want to wish you Peace. 

"Peace on Earth" is a phrase that is often associated with Christmas. It was part of the message that angels gave to shepherds in announcing the birth of Jesus. It's the one I always gravitate to at this time of year.

I've given this same message on Christmas many times to you all, and it feels like I'm just repeating myself. As much as I want there to be peace on earth every year, it seems like there is less of it. Even Pope Leo a couple of days ago asked the world for just 24 hours of peace. 

And it's not just conflicts between nations, but within nations, too. Where I live, there is so much division, so many people who won't even talk to one another because of what they see as their differences. They can't see that they have so much more in common. That turmoil in the world makes it hard to feel good inside -- to have some inner peace. 

And inner peace is what I wish for us all. 

I'm coming up soon on my 18th diagnosiversary. You'll read more about that in a few weeks.  In many ways, life as a Follicular Lymphoma patient gets easier with time. You come to believe that you really can live a "normal" life with this disease -- whatever "normal" means.

At the same time, 18 years as an FL patient means 18 years of an aging body. I was a young, healthy man when I was diagnosed at 40 years old.  I was running in 5k and 10k races, starting to train for a short triathlon, enjoying time with my young kids, and telling myself that 40 wasn't so bad. Now I'm closing in on 60, juggling three different Electronic Medical Records portals, arranging pill bottles so I don't take the wrong ones at the wrong time, and going to physical therapy twice a week for a knee problem that came out of nowhere. It's hard feel inner peace when you hurt your back just by sneezing too hard.

But I also remind myself that my wife and I walk two miles every day. I had a cardiac stress test not too long ago that the doctor described as "excellent for my age and gender." We're going to the Grand Canyon later this year, something we had planned to do almost 30 years ago. My FL is stable, and my  dermatologist didn't find any new skin cancer the last time I saw her. There's lots to be thankful for.  Lots of reasons to feel some peace.

I try to find peace in the small things. I can always find peace there.

I hope you can find some peace today, too. Maybe looking at the whole world might not do it. Maybe looking at your small part of the world might not do it, either.  

Look for the small, quiet places were peace tends to stay. Go there for a little while. Enjoy it.

I wish you a Merry Christmas, and many, many peaceful moments to come.