Dr Sharman on Immunotherapy for Indolent (low grade) Lymphoma - includes SLL!

[AussieNeil]

Dr Jeff Sharman has just posted a blog that will be of interest to anyone wishing to know more of the history of cancer treatment breakthroughs for low grade lymphomas which specifically includes Small Lymphocytic Lymphoma (SLL) and by association, CLL, plus it concludes with Dr Sharman's idea of where our next big breakthrough is likely to occur.

"If you look back over the last 60 years of advances cancer medicine, there are only a handful of clinical breakthroughs in low grade lymphoma (indolent) that fundamentally re-oriented our treatment strategies in the disease and upended the status quo of the time."

cll-nhl.com/2014/09/immunot...

The following drugs that should be familiar to us get specific mention: Bendamustine, Idelalisib, Iibrutinib, Revlimid, Rituximab and Vincristine.

Some interesting quotes:

Rarely a day goes by where I am not asked by a patient, “is there anything I can do to boost my immune system.” While my answer has always been, “not really” a number of very important new therapies are showing that harnessing the power of the immune system to attack cancer can be extremely powerful.

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B cell cancers have a remarkable ability to “put the T cells to sleep.” Whether though secretion of hormones, or actually manipulating the on/off switches of T cells, the cancerous B cells literally put the other half of the immune system into a post thanksgiving meal food coma.

This blog also includes a "Patterns of care data for indolent NHL 'slideshare'" for those of us wanting to know more.

Those of us with Small Lymphocytic Lymphoma (SLL) may also find Dr Sharman's earlier explanation of SLL very helpful:

cll-nhl.com/2012/12/the-slo...

His discussion on the staging differences between SLL and CLL is especially reassuring.

Perhaps someone that is familiar with both baseball and some better understood international sport could translate Dr Sharman's baseball introductory allegory. I'm afraid it went right over my head!

Neil

Photo: Black anther Flax lily flower (Dianella Revoluta), found on the roadside verge. Thanks once again to Jay for the identification.

[PaulaS Volunteer]

What an amazing flower! If you turn your head sideways, it looks like a multi-headed bird in flight! Well done Jay for all your identifying... Now I must read Dr Sharman's blog

P.S. I have now read Dr Sharman's blog. VERY interesting, and very clearly expressed. Certainly well worth reading. Thanks Neil.

[lankisterguy Volunteer]

Hi Neil,

Although I am not an avid baseball fan, I can translate the analogy (I hope you will explain Cricket to me someday).

Dr. Sharman wrote: “most advances are like getting a base hit. Doubles happen but are not terribly common, triples are rare, home runs don’t happen all that often and genuine grand slams change the field all together.”

Doubles and triples mean the batter gets to 2nd base or 3rd base, but cannot score (a run) unless someone else hits the ball after him and he can make it back to home base. So the CLL advancement must be supported by a later advancement to really make a difference in patient outcome.

Home runs are when the lone batter scores a run by himself. A grand slam is when a batter hits a home run with 3 people on the bases ahead of him- effectively scoring 4 runs with one hit "out of the park."

[lankisterguy Volunteer in reply to lankisterguy]

The second baseball analogy: " “Jeff, it sounds like you are swinging for the fences, and for our Stanford fellows, we are happy if you just crowd the plate and get hit by a pitch…” translates into:

Swinging for the fences- means to try to hit the ball hard enough to go over the fence & out of the park- the conventional way to score a home run. Most batters must concentrate on just hitting the ball, so swinging the bat very hard is risky.

Crowding the plate means standing close to the home base during the pitch, and if the batter is "accidentally" hit by the ball, anywhere but on the bat, he is sent to first base without having swung at the pitch. This would translate into having an "accidental" discovery/advancement instead of one you were trying very hard to achieve.

[AussieNeil Administrator in reply to lankisterguy]

Thanks Len,

I vaguely recall playing a game or two of baseball when at school and it is definitely a minor interest sport in Australia, so your excellent translation is very welcome. I can see how well it illustrates Dr Sharman's points.

As to cricket... well I have mates that are as keen in following their teams from the armchair as I understand many US men are when it comes to baseball, but you'll have to find another member (of which I'm sure there are many in the UK), that can explain the intricacies of cricket to you and me .

Neil