ASH: The Leonard List

Happy New Year!

I'm ready to take on another year of reading, thinking, and writing about cancer, after a few days rest. My wife and I just celebrated our 30th wedding anniversary, and we spent a few days at Rehoboth Beach in Delaware with some family. We have some very nice memories of times we have spent in that area, and we had beautiful mild weather that let us enjoy some walks along the beach.

I want to wrap up my look at the ASH conference with this year's Leonard List. This is a list of ASH presentations put out by Dr. John Leonard, a blood cancer specialist at Weill Cornell Medicine in New York. Every year, just before the ASH conference, he gives a "Top 10" list of the sessions he finds most interesting. They're not all about Follicular Lymphoma, but some are broad enough that they affect many blood cancer patients, including those of us with FL. (There was a lot of talk about Diffuse Large B Cell Lymphoma this year, and that's reflected in Leonard's list.) I'll have a just a few comments on some of the items on his list.

You can find Dr. Leonard's full list here, as a podcast. You can listen to him discuss his list, or read (or translate) a transcript.

#7B. A few times on the list, Dr. Leonard had two discussed two related presentation sat the same time. That's true for item #7, which looked at two presentations on racial disparities. #7B was abstract 2902: "Current Status of Racial and Ethnic Disparities for Follicular Lymphoma: A Surveillance, Epidemiology, and End Results (SEER) Database Analysis with Emphasis on Hispanics." This research looked at the SEER database, with information on almost 60,000 FL patients, and found that Hispanic FL patients were different from the average in the database -- they were diagnosed at a younger age, and were had a better survival probability at 2, 5, and 10 years, and better Overall Survival. Why is that the case? The data does not show why. The researchers seem to suspect there is some ind of biological difference that has yet to be discovered. I'm not sure what it might be, but I do find it fascinating that it might exist. Part of me wants to believe that we are all the same as human beings, but another part known that when we get down to the very smallest parts of us, there are probably some differences.

#5 on the Leonard List is another that is broken up into two parts.

#5A looks at abstract 798: Incidence of Second Primary Malignancies in Lymphoma Survivors: A Prospective Cohort Study in the Modern Treatment Era. I've written about this topic a few times recently -- the idea that as lymphoma patients, our immune systems, and the treatments we might receive, can make us more vulnerable to getting a second type of cancer, in addition to our lymphoma. Like earlier research, this one shows that Lymphoma patients are more likely to get another cancer (often another blood cancer or a skin cancer), and we need to be careful to get additional screenings, especially for skin cancer. A second blood cancer like leukemia would probably be found while we pay attention to our FL, but we need to stay aware of lots of other types.

#5B on the list is related, in that it looks at issues of survivorship -- what happens after treatment is finished. This one looks at abstract 448: "Reproduktiv Patterns Among Non-Hodgkin Lymphoma Survivors By Subtype in Sweden, Denmark and Norway." To summarize, patients with indolent lymphomas like FL had an easier time having children after diagnosis than patients with more aggressive Lymphomas. This could be because many FL patients have less aggressive treatment, or even watch and wait. This personally was not an issue for me, since my wife and I were finished having kids by the time I was diagnosed, and I'm guessing that's true for many FL patients, who are often diagnosed after age 60. But I know of plenty of people who were diagnosed earlier, and who had still hoped to have children. I like to think that oncologists are aware of this issue and make it a regular part of their discussions at diagnosis. There are certainly ways to help cancer patients who may hope to have children after treatment. 

Finally, Dr. Leonard offers five bonus abstracts after his top 10. (It's a good sign that his top 10 actually includes about 20 presentations -- there's lots to be excited about.)

One of the bonus abstracts is number 2907: "Administration of Obinutuzumab, and Not Rituximab, during Induction and Maintenance for Follicular Lymphoma Increases the Likelihood of Developing Delayed Neutropenia." As a reminder, Obinutuzumab is a monoclonal antibody, similar to Rituxan, thought to be an improvement on it. While it has some advantages over Rituxan, it also has some disadvantages, and this research points to another of them. Looking back at patient records, research found that 23% of patients who received Obinutuzumab with Bendamustine had delayed Neutropenia, which is a lowered level of a type of white blood cell that fights infections. While it is usually considered benign, a significant number of patients in this study were hospitalized because of it. This isn't necessarily a sign that Obinutuzumab shouldn't be give to patients, but Dr. Leonard thinks it should probably be a reason for some discussion about options when it's time for treatment.

So that's Leonard's List for ASH 2022. I like it because it covers so many aspects of being a Lymphoma patient -- not just looking at research on new treatments, but also at issues like survivorship, and thinking about how to make current treatments more effective. Our experience is so much more than just "the latest thing" (though I know I tend to focus on that myself).

And that's our lesson as we move into 2023 -- being sure we focus on our whole selves. Not just the physical, but also the emotional, spiritual, and any other aspects of our selves that allow us to live as full a life as we can.

I'll do my best to keep up the conversation.

Have a happy, healthy new year. Thanks for reading.