Novel Therapeutic Options for Lymphoma:
What Every Patient Needs to Know about Ibrutinib, Idelalisib, and Other New Drug
The Leukemia & Lymphoma Society (LLS) in partnership with Weill Cornell Medical College and NewYork-Presbyterian Weill Cornell Medical Center are presenting a patient education event on Wednesday, April 30 at Weill Cornell Medical College.
Click here to register or contact Trisha Ouellette at (212) 376-4762.
- General overview of lymphoma
- Clinical Trials/Select New Therapies
- Complementary Medicine
- Panel Discussion/Q&A
John Leonard, MD
Richard Furman, MD
Peter Martin, MD
Jia Ruan, MD
Date and Time:
Wednesday, April 30, 2014 5:30pm-8pm
The Griffis Faculty Club at Weill Cornell Medical College
521 East 68th Street (east of York Avenue)
New York, NY 10021
A light dinner will be provided
More information can be found here.
By Rebecca Elstrom, MD
Although rare, cancer, including lymphoma, does occur in pregnant women. The effect of both the cancer and treatment on the fetus is a major concern to expectant parents, adding to the stress of dealing with a diagnosis of malignancy. Some types of anti-cancer treatment, such as the anti-folate drug methotrexate, are best avoided at all stages of fetal development, and the effects of other classes are likely dependent in part on the physical characteristics of each drug, which can affect the ability of each to cross the placenta. For example, certain anthracyclines, which are critical in the treatment of lymphoma and other hematologic malignancies, cross the placenta poorly, whereas others, such as idarubicin and liposomal formulations of doxorubicin, have physical characteristics which allow greater penetration into the fetal circulation.
Fortunately, evidence is mounting that exposure of the fetus to many common types of chemotherapy after the first trimester does not produce negative effects on normal development, either in terms of organ development or neurologic function. A recent study published in the Lancet Oncology observed children born to mothers that were treated for cancer and compared their physical, behavioral and cognitive development to established norms in similar populations. The authors found that children born to mothers that were exposed to chemotherapy for treatment of cancer after the first trimester did not show notable differences in development from children in the general population matched for other characteristics. Although the numbers were too small to compare different chemotherapy regimens in their effects, the general finding of no significant decrement in development in this prospective study was encouraging. Of note, the most powerful predictor of cognitive developmental delay was premature birth, comparable to that seen in children born prematurely for other reasons. Although it is not possible to definitively rule out an additional effect of chemotherapy in this group, this finding argues that “iatrogenic prematurity,” or delivery of a baby before term for purposes of treating the mother’s cancer, is likely to be counter-productive, unless undertaken for a specific reason other than sparing the fetus exposure to chemotherapy.
Another critically important question involves the outcome of treatment for the patient. Pregnancy affects blood volume and could affect the body’s handling and metabolism of chemotherapy drugs. No large prospective studies are available to address this issue, but a presentation by Dr. Andrew Evens of the University of Massachusetts at the most recent meeting of the American Society of Hematology in December of 2011 showed excellent outcomes in a retrospective study of 88 women diagnosed with lymphoma during pregnancy. Weill Cornell Medical College participated in the study. Although the retrospective nature of the study and heterogeneity of the patients preclude definitive conclusions, this study provides more encouraging data for women facing a diagnosis of lymphoma during pregnancy. Click here to read the abstract.
By Rebecca Elstrom, MD and Glenn Schattman, MD
Dr. Elstrom is an Assistant Professor of Medicine at Weill Cornell Medical College whose clinical and research interests focus on the treatment of patients with lymphoma. Dr. Schattman is an Associate Professor of Obstetrics and Gynecology at Weill Cornell Medical College, specializing in reproductive endocrinology/infertility.
Preservation of fertility is a major concern in many patients with lymphoma, as many patients are within their child-bearing years at diagnosis. Furthermore, many young patients with lymphoma have a significant chance of being cured, making consideration of quality of life issues after lymphoma a critical aspect of care. Reliable data regarding the likelihood of infertility after chemotherapy however, have been difficult to come by. While many women may regain their menstrual cycles and possibly fertility, premature ovarian failure (POF), or menopause before age 40, can shorten the window of potential child-bearing following cancer treatment. Unfortunately, most studies use resumption of menstrual bleeding as a measure of fertility, though it is not a reliable indicator.
These issues are particularly relevant to patients with Hodgkin lymphoma, as peak incidence occurs at approximately 20 years of age, and most patients, even those with advanced stage disease, are cured. A paper recently published in the Journal of Clinical Oncology presented encouraging results for young women treated with ABVD chemotherapy, which is currently the standard approach in the United States. This study reviewed the reproductive outcomes of a subset of female patients treated on clinical trials within the European Organisation for Research and Treatment of Cancer (EORTC), and found that women less than age 32 who were treated with non-alkylating chemotherapy (such as ABVD) had no increased risk of POF (overall incidence 3%, similar to women in the general population), whereas those older than 32 years had a moderately increased risk of POF (9%). In contrast, women treated with alkylator-containing therapy, such as MOPP or BEACOPP, experienced a high rate of POF regardless of age, with an overall incidence of 60%.
Although this large cohort evaluation has shed light on the incidence and risk factors for POF in women with Hodgkin lymphoma, the data in women treated for non-Hodgkin lymphoma (NHL) are less clear. Continue reading “Fertility and Lymphoma”