Author: lymphomaprogram

Located on the Upper East Side of New York City, the Lymphoma Program at Weill Cornell Medical College/NewYork Presbyterian Hospital is internationally recognized for our efforts to enable patients with non-Hodgkin lymphoma, Hodgkin disease and related disorders to have the best possible clinical outcome, including cure when possible.

Tumor Blood Vessel Signals Linked to Cancer Lethality

Although the importance of blood vessels to cancer growth is well established, researchers at Weill Cornell Medical College recently found, that the cells that line the blood vessels of tumors are important in promoting the change of a slow-growing malignancy into aggressive, disease resistant strains.

Their finding, in the March 17 issue of Cancer Cell , challenges what was believed to be a fundamental dogma in cancer. It suggests that it is not simply the number of genetic mutations that occur in cancer cells that determines the aggressiveness of the disease. Rather, lethality occurs when the cancer hijacks the reparative function of blood vessels, a critical step that ensures tumor cells’ ability to spread and resist treatment.

The researchers also found the crucial nurturing molecules that cancer co-opts from tumor blood vessels to promote invasiveness and resistance to chemotherapy. They show in animal experiments that shutting down these previously unrecognized biological signals originating from tumor vessels makes cancer less aggressive and improves survival.

“The endothelial cells that line the vessels orchestrate a wide variety of biological processes — good and bad,” says the study’s senior investigator, Dr. Shahin Rafii, co-director of Weill Cornell’s Ansary Stem Cell Institute and Tri-Institutional Stem Cell Initiative, and a professor of Genetic Medicine. Dr. Rafii also is the founder of Angiocrine Bioscience, a startup anchored at Weill Cornell that is investigating how endothelial cells might be used to heal damaged tissues and regenerate organs – as well as target tumors. “The understanding and control of blood vessel function and how this changes the malignant behaviors of cancer cells is a transformative concept and will pave the way for designing innovative treatments that disrupt signals from the local environment housing the tumor cells- a strategy that has been unappreciated.”

Center for Lymphoma Announces the Formation of Adolescent and Young Adult Lymphoma Program

Lisa Roth, MD
Lisa Roth, MD

Recently the Center for Lymphoma announced the formation of the Adolescent and Young Adult (AYA) Lymphoma Program at Weill Cornell Medical College. The program is a collaborative effort between the Departments of Medicine and Pediatrics, and will be lead by Dr. Lisa Roth, a pediatric oncologist and new member of the Lymphoma Center.

Lymphoma is the most common malignancy in adolescents and young adults age 18-30y. While there has been remarkable progress in the treatment of children and older adults, improvements among adolescents and young adults have lagged behind. The reasons for this discrepancy are multifactorial, but include low enrollment in clinical trials, poor access to healthcare services, and a deficit in clinical and translational research in this area. The AYA Lymphoma Program seeks to advance the treatment of lymphoma in the AYA age group through the following missions:

1) Optimize medical care for AYA patients with lymphoma.

2) Provide psycho-social support tailored to AYA patients.

3) Lead clinical and translational studies aimed at improving outcomes in this age group.

Weill Cornell Medical College is in a unique position to treat AYA patients with lymphoma given the strengths of the Center for Lymphoma and the Division of Pediatric Oncology. Dr. Roth has been a Weill Cornell faculty member since joining the Department of Pediatrics in 2012. She is the Charles, Lillian, and Betty Neuwirth Clinical Scholar in Pediatric Hematology/Oncology and has been awarded fellowships from the Lymphoma Research Foundation and the Empire Clinical Research Investigator Program. Dr. Roth will work closely with a team of doctors, physician assistants, social workers, and researchers all with the common goal of improving outcomes for adolescents and young adults with lymphoma.

Ibrutinib and the Improvement in CLL Patient Care

Furman Face By Dr. Richard Furman MD

Ibrutinib is a first in line of new treatments, known as tyrosine kinase inhibitors that display promise in promoting improved response rates in refractory CLL patients. Unlike chemotherapy which cannot differentiate between healthy and cancerous cells, ibrutinib specifically inhibits the Bruton’s tyrosine kinase (BTK) enzyme in the body’s cancerous B-cells. By inhibiting the enzyme, ibrutinib deprives B-cells of their activating chemical signal. This enzyme is expressed only in B-cells, allowing ibrutinib to exclusively target B-cells, affording a tremendous amount of specificity. This specificity allows for an excellent tolerability of ibrutinib in CLL patients, thus increasing quality of life.

This is significant for CLL patients as chemotherapy treatment often comes with disadvantages. A patient achieving a complete recovery will experience marrow toxicity, and be at risk of developing secondary acute myeloid leukemia and/or myelodysplastic syndrome. Even common CLL regimens like FCR (fludarabine + cyclophosphamide + rituximab), expose patients to major risks.

These initial disadvantages are exacerbated by patient relapse and further chemotherapy. For example a patient, who at diagnosis exhibits a very good response to their first line of chemotherapy treatment and another positive response in their second line of chemotherapy, would ultimately be given a 7-9 year median survival rate from their initial chemotherapy. Unfortunately, survival past that 9 year rate is unlikely, as increased chemotherapy leads to a corresponding decrease in longevity. Any increase in longevity beyond that 9 year mark would require treatment besides standard chemotherapy agents. Accordingly, length of survival is the long term promise and improvement held by tyrosine kinase inhibitors like ibrutinib. The side effects associated with chemotherapy regimens are non-existent for ibrutinib.

Due to the nature of currently available chemotherapy treatment, successful benchmarks are increasingly focused on complete response and partial response rates with chemotherapy, and not on overall survival. Chemotherapy focuses on the complete response, partial response, and minimal residual disease status of patients. Conversely, ibrutinib and other similar treatments display significant improvements towards progression free survival and overall survival, even when accounting for patients who develop resistance and require additional therapy.

Increasingly, the avoidance of chemotherapy is the most important aspect of CLL therapy. My hope is to begin using tyrosine kinase inhibitors like ibrutinib earlier in treatment, and avoid chemotherapy. This would lead to vast improvements in patient quality of life and the important metrics of long term survival.