Friday, April 13, 2007

Should Fred Thompson Run given his Non-Hodgkins Lymphoma?

Short answer No! 
  1. Fred Thompson's age is a strike against him
  2. It is not a curable disease as of yet
  3. It can relapse and progress to a more aggressive form
  4. You can treat relapses successfully and can be managed like a Chronic Disease.
  5. Even with the newer Monclonal Antibody Therapy(Rituxan) the 5 year death rate is ~31%(Rituxan decreases mortality by ~6%)
OK, now the long answer with citations because this question is hard to answer. Especially since I don't want to write something that may get repeated and then get you shot down by a Fred T. expert M.D. such as Dr. Bruce D. Cheson, his Oncologist, a well known expert(here is an FDA article from 1996 which quotes him on NHL) for NHL and is a clinician/porfessor and Chief of Hematology in the Hemotology/Oncology division at Georgetown University Hospital in Washington. 
  • "Right now, he has no evidence of disease," said Dr. Bruce D. Cheson, head of hematology in the division of hematology/oncology at Georgetown University Hospital in Washington. Many such patients "can live a normal life span," he said.
    Cheson described his 64-year-old patient's disease as an "indolent lymphoma -- slow growing." (Watch the doctor talk about living "as normal as possible" Video)
    Patients with this form of disease "can live a normal, productive life, often dying from unrelated causes," Cheson said. He described Thompson's prognosis as "very favorable."
    The diagnosis was made late in 2004, when Thompson sought treatment for a 3.5 centimeter by 4 centimeter (roughly one inch by 1½ inch) lump under his left jaw and the biopsy came back positive, Cheson said.
    Thompson was initially treated with radiation to his neck, "merely because it was bothersome to him to have a lump there."
    "The indolent, or slow-growing lymphomas are very treatable, but rarely if ever curable," Cheson said. "Therefore, his likelihood of recurring is high, but this may not happen for a number of years."
Estimated new cases and deaths from non-Hodgkin's lymphoma in the United States in 2007:  New Cases 63,190 Deaths 18,660= 30%  from  National Cancer Institute.  Now they have not broken this % down by type of NHL(milder or Indolent vs the Aggressive one are lumped together).  I'll see if I can further parse.  The ~40%(37%) I have stated before,comes from the Mayo Clinic, included all Non-Hodgkins Lymphoma so the type Fred T. has may have a lower Mortality over 5 years if taken alone?
First, I have not be able to ascertain the Stage of his NHL when first diagnosed, other than "Indoent" type. Probably Stage I od II.
Here are the Bullets:
  • Indolent (low-grade) non-Hodgkin's lymphoma is generally not curable, but is typically slowly progressive and responds temporarily to therapy.
  • Aggressive and highly aggressive (intermediate- and high-grade) NHL's are potentially curable with combination chemotherapy.
  • Long-term survival or cure rates for these diseases vary with a number of prognostic factors.  
  • After being diagnosed, Thompson received radiation first. But then doctors noticed growth of additional lymph nodes and gave him Rituxan, the first in a new generation of drugs that over the last decade has revolutionized lymphoma care. Rituxan is made of monoclonal antibodies, cells engineered to hunt down the cancer by recognizing an antigen on its surface and kill it without doing the harm to surrounding tissue that chemotherapy would.
  • Indolent forms like Thompson's, which is known as "marginal zone lymphoma," are not curable. But they're easier to push into remission, repeatedly if need be, with doctors treating it as a chronic disease.
  • Basically, this new treatment,Rituxan, does not cure the cancer but it doubles the time it takes for a relapse to occur(from 1.4 to 2.4 years in one study).
  • At least three major trials have shown that the chance of disease progression is decreased by ~50% with the addition of Rituximab to chemotherapy(I know he got Radiation but I have not read he got Chemo).   
  • A recently trial also reported an improvement in survival of about 6% at the end of 3 years 
After treatment for non-Hodgkin's lymphoma, the response is classified as follows:
  • Complete Remission (CR): disappearance of all detectable disease.
  • Partial Response (PR):  reduction in the bulk of disease by at least 50%, but with some remaining disease.
  • Stable Disease: Less than a partial remission, but no progression of disease and no new sites of disease.
  • Progressive Disease: Growth in bulk of disease by >50%, or the appearance of new sites of disease.
  • Non-Hodgkin's lymphoma paitents need to have regular followup examinations after their treatment is over.
  • Standand guidelines dictate that a patient be monitored for relapse every three months in the first year following a complete remission
  •  every six months in the second year,
  • and finally once annually in the third and later years.
  • Currently, if a patient maintains a complete remission for 3 years, the patient is considered cured.(I don't know if this is the standard position among Onclologist at present?)
Long winded but as complete as I can make it. 
I'll post a non-personal version of this on the Slalom Course
p.s.  If Fred T. runs then he should pick Mitt Romney as his running mate in case his Non-Hodgkin's Lymphoma(NHL) relapses.

Ahhh...imagining that irresistible "new car" smell?
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