logo
ENFRع
#

Latest news with #bloodcancer

Cilta-cel CAR T: Myeloma ‘Cure' and Conjecture
Cilta-cel CAR T: Myeloma ‘Cure' and Conjecture

Medscape

timea day ago

  • Health
  • Medscape

Cilta-cel CAR T: Myeloma ‘Cure' and Conjecture

Not a day goes by in clinic without a patient asking about the recent New York Times article on multiple myeloma: "Doc, is there really a cure now? I want this treatment." The article was boldly titled "From No Hope to a Potential Cure for a Deadly Blood Cancer." But did we truly leap from "no hope" to "potential cure"? In this commentary, I explore what the article got right, where caution is warranted, and how I think about the notion of a cure for myeloma. Manni Mohyuddin, MD Historically, patients with heavily pretreated, relapsed myeloma had grim prognoses, often with less than a year of survival. The arrival of BCMA- and GPRC5D-directed therapies has rewritten expectations for this population. Cilta-cel, a BCMA-targeted chimeric antigen receptor (CAR) T-cell product, is a standout. A recent long-term follow-up study in Journal of Clinical Oncology (JCO) reported that one third (32 of 97) of patients remained progression-free 5 years after a single cilta-cel infusion. It's a remarkable outcome, one worthy of celebration, yet we must interpret these results with care. Of the 113 enrolled patients, only 97 received cilta-cel, and only the outcomes of those 97 are described, with the unfortunate ones whose disease progressed before cilta-cel infusion omitted from this narrative. Patients with rapidly progressing or unstable disease often don't make it to CAR T — a natural selection bias. Moreover, heavy censoring at the tail end of the Kaplan-Meier survival curve, a statistical method used to track patient outcomes over time, and where many patients drop out or are lost to follow-up, introduces uncertainty about what the results will be with even longer follow-up. A real-world study of cilta-cel showed 12-month progression-free survival (PFS) at just 68%, making it unlikely that we will see such outcomes with 5 years of follow-up in the real world, and highlighting the gap between clinical trial efficacy and real-world effectiveness. This discrepancy is not new. The MAIA study reported a median PFS beyond 5 years for newly diagnosed patients treated with daratumumab, lenalidomide, and dexamethasone (DRd). Yet, in real-world cohorts, PFS is closer to 2-3 years. Differences in censoring, progression definitions, and patient selection drive this gap. Given these dynamics, a 30% five-year PFS in real-world practice for this patient population seems unlikely. While some patients, perhaps 10%-15%, may experience truly durable responses, presenting the trial's cure fraction as broadly achievable would be misleading. The word "cure" featured prominently in both the JCO publication and the New York Times article. However, the most recent definition of cure in myeloma includes sustained measurable residual disease (MRD) negativity off all therapy for at least 5 years. When asked, patients have clearly indicated that they do not consider themselves cured while still on treatment (as is often the case in myeloma), no matter what the disease response is. I celebrate this trial for many reasons, but one important one is that it gave patients such valuable time off from treatment. However, during long-term follow-up of this trial, MRD negativity was not routinely assessed. At one center, 12 patients were evaluated serially and found to be MRD negative. But this was a post hoc analysis, and data from other centers weren't reported. Given the nuanced ways that relapse is defined in myeloma (with markers having to be above a certain threshold), we must be cautious in declaring these patients cured. Some of them may already have signs of relapse that has not yet reached a certain threshold to call it as progression. I also must admit to feeling distressed that a top-notch journal allowed the authors to make such bold statements based on post hoc analysis from a single center. Such post hoc data mining — where researchers look for patterns after seeing the results — carries a high risk for false discoveries and should not support definitive claims about cure. The article implies that these long-term remissions and cure are unprecedented. That's simply not true. Long-term follow-up from studies using intensive upfront therapy have shown that many patients — especially those with standard-risk disease — achieve long remissions, are off treatment, and remain alive for years. To claim that we've gone from "no hope" to "potential cure" neglects this important context. Myeloma had seen sustained, incremental progress across multiple drug classes well before cilta-cel emerged. Cilta-cel is a powerful therapy, but it is not without risk — something the article omits. It has horrendous, unpredictable toxicities that were not mentioned in the New York Times article. These include secondary cancers, a horrible diarrhea due to immune-mediated gut damage, and often irreversible neurologic damage. Thankfully, these are not experienced by the majority of patients, but we are imperfect at predicting to whom they do happen, and many of these toxicities are currently permanent. Despite these critiques, I view the New York Times story as a net positive. It raises awareness about the progress we've made and offers patients hope. I do believe we are curing some patients with myeloma, and cilta-cel is part of that story. However, the 30% cure rate cited in the article is probably an illusion among such a heavily pretreated population (although I am hopeful for an even higher cure rate in the newly diagnosed setting). I envision a future with safer therapies that more reliably increase the cure fraction. And while I appreciate how this article shined a spotlight on myeloma, I hope that future media coverage embraces the nuance that this disease — and its patients — deserve.

Cancer devastated me – but I started shaking when I realised my 20-year-old TATTOO could be to blame
Cancer devastated me – but I started shaking when I realised my 20-year-old TATTOO could be to blame

The Sun

time4 days ago

  • Health
  • The Sun

Cancer devastated me – but I started shaking when I realised my 20-year-old TATTOO could be to blame

THE row of hearts tattooed around Melanie Rushforth's left arm symbolises her love for her family. Her mum Margaret, whose middle name was Rose, is remembered by a flower on her right shoulder. Melanie, 58, has been getting inked for 20 years - but regrets it all, knowing what she does now. 8 The administrator is midway through treatment for lymphoma – a type of blood cancer. In March, a study by the University of Southern Denmark found a link between tattoos and an increased risk of developing blood cancers, including lymphoma. In fact, the increased risk could be as much as 170 per cent, something Melanie wasn't aware of during her various tatts between 2005 and 2016. It was only after being diagnosed in April that she became aware of the connection. 'In February I noticed a lump on my neck,' Melanie, who is married to Ian, 62, an HGV driver, tells Sun Health. 'At first, I didn't think much of it. But I have an underactive thyroid, so I decided to get it checked just in case. 'The doctor didn't seem too concerned. He ordered some blood tests and told me to come back in four weeks if the lump didn't go down. 'The blood tests were fine; he thought it might have been glandular fever, but that came back negative. 'By the time the four weeks were up, the lump had gone, so I didn't go back.' But two weeks later, Melanie's lump returned - much bigger and more painful than before - so she made another appointment with her GP. People with tattoos have a 21% higher risk of lymphoma blood cancer - even if they're tiny, study suggests 'I thankfully saw the same doctor, and that's when he first mentioned the possibility of cancer,' she says. 'He said it might be nothing but sent me for an ultrasound and possibly a biopsy.' The scans showed Melanie had lymphoma, a type of blood cancer that originates in the lymphatic system. 'I was diagnosed with diffuse large B-cell lymphoma – DLBCL,' she says. One of the main symptoms of Melanie's condition is swollen lymph nodes, but others include pain in the tummy, chest or bone, night sweats, a high temperature and unexplained weight loss. Melanie, who works at the University of Lincoln, says: 'It's in one spot on my neck and classified as stage one. 'Thankfully, it was caught early so I'm on a chemotherapy regimen called R-CHOP which is six sessions, one every three weeks. 'I had my third session on June 30 and treatment should finish by late August or early September, when I might switch to radiotherapy depending on how things go.' While Melanie's consultant told her not to turn to Google to check her diagnosis, it was while researching the condition she found the link between tattoos and cancer. The latest study, published in BMC Public Health, analysed the health data of 5,900 twins born between 1960 and 1996 up until 2017. Over the course of several decades, the risk of lymphoma - a type of blood cancer that affects the immune system - was found to be three times higher for those with large tatts. 'For larger tattoos – those bigger than the palm of a hand, the hazard was 140 per cent,' study author assistant professor Signe Bedsted Clemmensen said. 'We found that people with tattoos had a 60 per cent higher hazard – a measure of 'immediate risk' – of developing skin cancer compared to those without tattoos.' Prof Clemmensen says the study findings are a long time overdue. 'Our study found evidence of associations between having tattoos and development of lymphoma and skin cancer,' she says. 'While this doesn't prove causation, it highlights a potential health concern that warrants further investigation. 'It has long been known that tattoo ink doesn't just stay in the skin. It also accumulates in nearby lymph nodes.' 8 8 She explains that this is one of the potential mechanisms that could explain why tattoos might lead to cancer. 'Firstly, there are carcinogenic properties of substances used in tattoo ink,' Prof Clemmensen says. 'Secondly, we suspect that tattoo ink as a foreign substance can cause chronic inflammation in the lymph nodes, which over time can lead to abnormal cell growth and an increased risk of cancer. 'Despite repeated calls from health authorities for research into the potential long-term health effects of tattooing, there were no scientific studies addressing this issue when we began planning our study. 'That gap in knowledge is what prompted us to take a closer look.' What are the signs of lymphoma? LYMPHOMA is a term for cancer that starts in the lymph system - a network of vessels and glands that spans your body. There are two main kinds of lymphoma – Hodgkin Lymphoma and Non-Hodgkin Lymphoma. Lymphoma can cause many different symptoms, depending on which type of lymphoma it is and where it develops in the body. The most typical signs are: Swollen lymph nodes, such as in the neck, armpit or groin area Night sweats Extreme tiredness Itching Unexplained weight loss Fever Excessive bleeding, such as nosebleeds, heavy periods and spots of blood under the skin Other signs of lymphoma in a more localised area include: Swelling of the stomach, loss of appetite and other abdominal symptoms Coughing, shortness of breath, or chest pain Dr Rachel Orritt, health information manager at Cancer Research UK, said: 'There isn't enough evidence to say that tattoos increase people's cancer risk, and more research is needed. 'This is a difficult area to study, because there are lots of different possible ingredients in tattoo ink, making it tricky to understand the effects. 'If people are concerned about their cancer risk, there are proven steps they can take to reduce it. 'These include not smoking, keeping a healthy weight, and enjoying the sun safely.' For Melanie though, the realisations that her tattoos could have caused or contributed to her condition has been incredibly difficult to deal with. She says: 'My husband and I were searching everything, and I came across a couple of articles linking tattoos to lymphoma or blood cancers. It understandably really worried me. 'I have four tattoos and I'd planned to get another this year to cover a scar on my leg. 'I was shaking when I read those articles though. I started to wonder, 'Have I done this to myself?' 'It added a whole new layer of stress.' 'Like a phoenix rising from the ashes' While Melanie's diagnosis could be entirely coincidental, Prof Clemmensen suggests the research is too hard to ignore. She says more education is needed so people can make informed choices. 'Ultimately, it's a personal decision,' she says. 'Each individual must consider whether they're comfortable with the potential health risks associated with tattooing. 'As with smoking, alcohol consumption, or highly processed foods, it's important that people have access to reliable information. 'Our role as researchers is to provide that evidence so individuals – and policymakers – can make informed decisions.' Melanie had planned to get a post-cancer tattoo, which she is now scrapping. 'It was of a phoenix rising from the ashes,' she says. 'It felt symbolic - about survival, rebirth, and strength - but I won't get anything done for the foreseeable future – not after reading the study. 'I love body art. It's a personal expression, but I won't get any more tattoos.' 8 8

DOWNLOAD THE APP

Get Started Now: Download the App

Ready to dive into a world of global content with local flavor? Download Daily8 app today from your preferred app store and start exploring.
app-storeplay-store