Thursday, November 7, 2013

Dr. Cheson on Follicular Lymphoma

Apparently, Matt Lauer and Al Roker got live prostate exams on the Today Show this morning, to raise awareness during Prostate Cancer Month. This is a link from a news story yesterday that said it was going to happen.  I'm not including a link to the actual show, because I don't really care to watch Al Roker get a prostate exam. Besides, "I'd rather watch Al Roker get a prostate exam" sounds too much like a Jay Leno punchline.

There -- I've done my part to promote prostate cancer awareness.

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Lymphoma Rock Star Dr. Bruce Cheson gives us the State of the Art in managing Follicular Lymphoma, in an interview with Clinical Oncology News. Dr. Cheson is Head of Hematology at Georgetown University Hospital in DC, and he's a very visible expert on Follicular Lymphoma, appearing online to explain things clearly. (And frankly, I need something from someone like him, given my last couple of posts. This interview comes at a good time.)

It's not a long interview, so I'll give you what are for me the highlights:

Dr. Cheson was asked the difference between FLIPI and FLIP-2, and how a score influences his treatment decisions. FLIPI stands for Follicular Lymphoma International Prognostic Index, and it was designed to help doctors gauge patient outcomes, and thus how aggressively to treat. It's a funny index; it's best to think of it as an estimation of where you are, not a prediction of what will happen. The difference between the two is FLIP-2 is a more recent creation, and takes into account he difference that Rituxan has made on treatment. What the FLIPI indexes will not tell you, though, is when to treat.

For that decision, Dr. Cheson consults the GELF criteria (the name comes from the Groupe d’├ętude des Lymphomes Folliculaires, a French study group for Follicular Lymphoma). GELF lays out some of the physical properties that might make it a good time to treat (things like lymph node size and some blood counts).

The "when" question, of course, assumes that treatment isn't necessary immediately, which again brings up the issue of Watch and Wait. Dr. Cheson gives his take on the W & W controversy, one that I agree with. First off, he wisely mentions that importance of taking psychological and emotional factors into consideration. Physical factors aside, some patients want to be treated right away. Others, conversely, feel better knowing they can hold off treatment. GELFs and FLIPIs mean nothing until the doctor understands how it affects the patient emotionally.

From there, Dr. Cheson reviews the research on Watching and Waiting. His conclusion? He still uses it for patients in certain situations. 

Dr. Cheson closes with a discussion of curability, mostly with regards to Stage I and II disease, which are diagnosed only about 15% of the time. But he has some thoughts on the curability of later stage disease, too, that are worth considering. (No, Follicular Lymphoma is still not curable, but Dr. Sheson suggests we might re-think what that means in the long term.)

Overall, it's a nice summary of where we are with Follicular Lymphoma, from a well-known expert. There's a part 2 for next month, with his thoughts on front-line treatments and maintenance therapy. Looking forward to that one.

1 comment:

Anonymous said...

Now thats a great article, my husband is on W and w (everything is ok from his last scan and blood work in Sept) I had doubts about the approach after i read an article from your blog about initial management strategies might influence risk of transformation, but W and W is suitable for his condition according to this, thank you for posting - Jeanne