Follicular Lymphoma – Living with a Lifelong Blood Cancer [transcript] [audio]

Guest: Dr. Alexey Danilov

Presenter: Neal Howard

Guest Bio: Dr. Alexey Danilov is Associate Professor of Medicine at the Knight Cancer Institute Hematology and Medical Oncology, in Portland, Oregon. He earned his medical degree and PhD at Yaroslavl State Medical Academy in Russia and completed a fellowship in hematology/oncology at Tufts Medical Center, in Boston, Massachusetts. Dr. Danilov runs an independently funded clinical/translational program in chronic lymphocytic leukemia (CLL) and non-Hodgkin lymphoma (NHL) that bridges the understanding of B-cell biology with early clinical evaluation of novel therapeutics. He spearheads a translational and early-phase therapeutics effort in B-cell malignancies at the Knight Cancer Institute. He has characterized promising therapeutic agents with regard to their mechanism of action and resistance, ushering them into early-phase clinical trials in CLL and NHL. He seeks to translate his findings to clinical care by developing protocols that advance current treatment paradigms. His work has received support from the Leukemia & Lymphoma Society, Lymphoma Research Foundation, the National Cancer Institute, and the Southwest Oncology Group, among other organizations. His work has been published in numerous peer-reviewed journals including Clinical Cancer Research, Cancer Research and Molecular Cancer. His research is consistently featured at national and international meetings.

Segment Overview: Dr. Alexey Danilov is Associate Professor of Medicine at the Knight Cancer Institute Hematology and Medical Oncology, in Portland, Oregon, discusses Chronic Blood Cancers, such as Follicular Lymphoma, and available resources.

Transcript

Neal Howard: Hello and welcome to the program. I’m your host, Neal Howard here on Health Professional Radio. Thank you for joining us. You may not think of cancer as a lifelong disease but that’s the case for many people that are suffering with certain slow growing forms of cancer. Now, here to share more about some chronic blood cancers and some resources available is medical oncologist Dr. Alexey Danilov. Welcome to the program, doctor.

Dr. Alexey Danilov: Thank you so much. Thank you for having me here. There is quite a few blood cancers there which are not common but blood cancer in and of itself is actually very common. About 1 million people live with a diagnosis of blood cancer in the United States and someone gets diagnosed about every three minutes and unfortunately we lose a life to a blood cancer or its complications every 9 to 10 minutes or so. In fact blood cancers are not that rare and while under that umbrella there are some more rare subtypes in general. It is a fairly common diagnosis.

N: Well, what’s an example of one of these chronic blood cancers?

L: So chronic or what they call them, we call them indolent slow-growing blood cancers would be something like follicular lymphoma which is actually fairly common about close to 20,000 people get diagnosed every year. Another example is chronic lymphocytic leukemia. Even though it says the word leukemia in the name, it is actually a Non-Hodgkin lymphoma that’s another 20,000 people. What makes them different from acute leukemias or aggressive lymphomas is that they do not necessarily start therapy at the time of diagnosis for those indolent slow growing cancer such as follicular lymphoma. So 4 or 5, 6 years may pass often before we initiate treatment for follicular lymphoma and treatment is done based on emergence of symptoms or certain disease complications and this is not necessarily an ominous sign. It’s not because we do not have good people for those conditions it’s because actually follicular lymphoma can stay under good control without our interference and we used what we call a watch and wait approach for follicular lymphoma, CLL, some other informants as well.

N: So a watch and wait approach. Once you’ve watched, what are the treatment options?

L: Different options are quite many at this point and they are constantly improving I should say. Over the past 20 years there’s been a significant improvement in outcomes in lymphoma including follicular lymphoma and part of that improvement came from development of new drugs. We use chemotherapy. We often use drugs such as Bendamustine or cyclophosphamide. We use antibody therapy, immunotherapy. Examples there will be obinutuzumab or Gazyva which was approved in the past year for treatment of some patients with follicular lymphoma. Rituximab, an antibody drug which we have used for over a decade and those that certainly are improving outcomes in this disease. Well, none of them are 100% safe. So those drugs do have their own side effects and they can cause certain complications. However in this day and age, we are able to choose the right therapy for patients based on these manifestations and based on the patient needs. So there is not necessarily one-size-fits-all approach and patients should really talk to their physician about what’s right for them, but we are becoming much better at treating the right therapy from the arsenal that we have for everybody.

N: As common as you say follicular lymphoma is, who is affected more?

L: Well, generally follicular lymphoma, chronic lymphocytic leukemia are more common among folks in their 60s and 70s. So all the people are more likely to develop those conditions in younger people. Although, I do have a few younger patients in their 30s and 40s with diagnosis of follicular lymphoma.

N: Treatment options do they differ greatly based on a person’s age or as you say normally they get them up in years but you get those special ones, you get them earlier in life or the treatment options identical?

L: Yes. The initial approach may be similar. We typically think of follicular lymphoma as incurable disease. For younger patients the option, this becomes more complicated question because if someone gets diagnosed in their early 30s, mid-30s, we are looking at a general life expectancy of 50 years which we have to support them through. So this is a group of patients where we begin to think about cellular therapy stem cell transplant. So that is a very complicated topic. It’s certainly not for everybody and not for many older, not a good option for me, all the patients with follicular lymphoma but this is right now the only curative approach that we have.

N: Is it difficult to find some of these treatment options based on the level of your disease?

L: Well, in general most of those treatments are effective in follicular lymphoma. We are usually able to choose the right therapy or combination of chemo immunotherapy or something else. There are certainly a few options out there which we are able to choose from. So for most patients, they’re able to choose the right therapy.

N: Where can we go online and learn some more about follicular lymphoma and some of these other slow-moving forms of blood cancer?

L: Lymphoma Research Foundation runs a great website, lymphoma.org which they have recently redesigned, it’s a little organized, has a lot of good information on it. Leukemia & Lymphoma Society is another organization that funds a lot of exciting registration in the field of lymphoma. So I would recommend those two highly.

N: Great. Well, I thank you for coming in and sharing with us today.
L: Thank you very much.

N: You’ve been listening to Health Professional Radio. I’m your host, Neal Howard in studio with Dr. Alexey Danilov. Transcripts and audio of the program are available at healthprofessional radio.com.au and also at hpr.fm. You can subscribe to our podcast on itunes listen in and download it at soundcloud and visit our affiliates page at hpr.fm.

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