Friday, April 25, 2014

Predicting a Follicular Lymphoma Diagnosis

Fascinating research from France published in the Journal of Clinical Oncology: a genetic test might predict a Follicular Lymphoma diagnosis long before the disease shows up. (Not that any such test exists at the moment. Read on.)

Researchers from France (and I mean pretty much every lymphoma researcher in France, from the looks of the list of authors) tapped into the 520,000 people participating in a European study of cancer and nutrition and found 100 people with Follicular Lymphoma. Going back to earlier blood samples from this group, they found that there was a link between Follicular Lymphoma and a translocation of the (14;18) chromosomes.

This particular bit of information isn't new; we've known for a while that (14;18) translocation is present in Follicular Lymphoma cells. I'm not going to get too much into genetic stuff, but basically what happens is this: chromosomes play a key role in cell division and replication. They make sure that DNA (the blueprint for cells) divides properly when a cell divides. Humans have 23 pairs of chromosomes, so it's easy to number them. "Translocation" means the chromosomes have changed their location. As you can imagine, when something that supposed to help organize a cell splitting gets mixed up itself, there are problems. It's kind of like putting a drunk guy in charge of a bakery -- you're going to get some messed up cupcakes.

And that's what cancer is, really -- a bunch of messed up cupcakes.

Anyway, for Follicular Lymphoma, there is a translocation of the number 14 and number 18 chromosomes. Drunky McBaker added a half cup of salt when he should have added a half cup of sugar. Your salted caramel cupcakes end up way too sweet, and your red velvet cupcakes end up way too salty. And the baker is passed out behind the stand up mixer, so he's no help.

Back to Follicular Lymphoma: when the (14;18) translocation happens, the normal signals to the cells get mixed up, and we end up with problems. In this case, the problem is a bad one: a cell that has lost the ability to die. And that's what cancer is, in a nutshell. (Or a cupcake wrapper.)

What is significant about what this group of researchers from France have discovered is that the (14;18) translocation can be detected long before there is an official diagnosis of Follicular Lymphoma: up to 15 years before diagnosis.

That's pretty amazing.

Now, the real question is, what are the implications of this?

For us, as current patients, probably not much, at least directly. Knowing that I might have had a better shot at getting lymphoma 15 years ago doesn't do much for me now.

Will it help others in the future? Maybe. But I'm not sure, at this point, that it will. It would mostly give them something else to worry about for 15 years.

The really helpful thing it might do, though, is help researchers track changes over time that lead from the translocation to the need for a diagnosis. Maybe they can track changes in the microenvironment that cause the translocation to develop into full-blown FL. Understanding the disease's path will provide information on ways to impede that path before it gets out of hand.

In some ways, the indolent nature of Follicular Lymphoma may be a blessing, if its slow growth allows us to see a clearer picture of what's happening.

I think this is one of those research reports that is a bigger deal than it seems at the moment. It's not a "Hey, we added 2 years to Overall Survival!" report. But it's one that adds just a small piece to the big puzzle, and it might turn out later to be a very key piece.

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