Monday, May 21, 2007

Senator Fred Thompson's Lymphoma Prognosis from a blogging Medical Columbo

From my research I believe former Senator Fred Thompson had Follicular Lymphoma, the most common of the Low Grade Lymphomas. I do not know the stage and subtype which matter. However, the Press indicates he was treated with a new treatment Rituxan.
  • last published 5 survival rate is 50% for Stage 1 and 25% Stage II
  • Transformation to High Grade is anywhere from 25-60% early on
  • or 28% over 10 years.
  • Sometimes, a low grade and higher grade lymphoma can be there at the same time, in the same person. Even in the same lymph node. If this happens, your doctor may assume that it is in the process of transforming to the higher grade type.
    After a low grade NHL has transformed, it has to be treated as high grade.
  • Unfortunately, a transformed NHL is harder to control than it was when low grade. And the treatment is more intense. from
Conditional Survival: Each year a patient survives lymphoma the expected 5 year survival increases:.
This statistic is called the
Conditional 5-Year Relative Survival Rate

Limits of statistics: Finally, statistics take time to compile and cannot show the influence of new therapies until many years later. These calculations are best used to show trends on large groups, not to predict an individual's prognosis.

How did I figure this out? Here is my thinking and research thread:

Fred Thompson acknowledged that he had been treated for a form of non-Hodgkin's lymphoma however are still a bunch of NHLs. A Clue that know one has mentioned is that he was treated with Rituxan, a drug only useful against Follicular lymphoma a Non Hodgkin's Lympohoma!

  • Current estimates of median survival for indolent follicular lymphoma, the most common form of NHL, range from 8 to 10 years.
  • Approximately 50% of patients with stage I indolent follicular lymphoma, and 25%with stage II disease, can be cured with radiotherapy, but the overwhelming majority of patients are diagnosed with advanced disease.
  • The survival for indolent lymphomas is dependent on cell type and other prognostic indicators. It will take time to determine if new treatments will improve overall survival, but there are reasons to be encouraged.
Who can be treated with Rituxan?

Rituximab is licensed to treat low grade follicular NHL. This is the commonest type of low grade NHL. About 40 out of every 100 (40%) of low grade NHL's are follicular. Rituximab is used to treat low grade follicular NHL that

  • Is resistant to chemotherapy
  • Has relapsed at least twice after successful treatment with chemotherapy
For most people in these situations, there is no other treatment available. About half of those with follicular NHL respond to rituximab. The average time before the NHL begins to grow again is about a year. Remember this is the average – remission will be shorter in some people and longer in others. When the NHL does start to grow again, you can have more rituximab treatment.

Low grade non Hodgkin's lymphomas

  • Follicular

  • Small cell lymphocytic (or chronic lymphocytic leukaemia)

  • Splenic marginal zone lymphoma

  • MALT lymphoma

  • Lymphoplasmacytic NHL (also called Waldenstrom's macroglobulinaemia)

Of these, Follicular lymphoma is the commonest type of lymphoma. About 40 out of every 100 (40%) low grade lymphomas diagnosed are this type. There are subtypes called grades 1, 2 and 3. Grade 3 follicular lymphoma is more aggressive and is likely to be treated as a high grade lymphoma.
Transforming from low grade to high grade

Over time, low grade lymphomas may change into a more aggressive high grade type lymphoma. This happens to between 15 and 30 out of every 100 people diagnosed with NHL, depending on the type they have. So it doesn't always happen. If it does, it may be several years after you were first diagnosed with the low grade lymphoma.

What is the risk of histologic transformation of low grade indolent lymphoma to High Grade?

The answer is an estimate, and depends on how you ask the question, the time period, and who you ask:

The risk of histologic transformation (HT) by 10 years was 28%. 1
Transformation to more aggressive large cell lymphoma occurs in 25-60% of pts with FL 4
Thanks for Reading and I pray that Senator Thompson, Press Secretary Tony Snow, Mayor Giuliani, Senator McCain and John Edward's wife Elizabeth are all cured of their cancer and live healthy live to a ripe old age of 100 years!. But I want Governor Romney to be President!


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