No improvement seen in HIV-associated lymphoma survival during the antiretroviral therapy era

Main Category: Lymphoma / Leukemia / Myeloma
Also Included In: HIV / AIDS
Article Date: 30 Jul 2013 - 0:00 PDT Current ratings for:
No improvement seen in HIV-associated lymphoma survival during the antiretroviral therapy era

Stable survival rates were observed for HIV-associated lymphoma patients during the antiretroviral therapy (ART) era in the US, according to a new study published in the Journal of the National Cancer Institute.

Studies have shown that HIV infection increases the risk of non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL) and that incidence for many lymphoma types has not decreased in the ART era. Furthermore, lymphoma is the most frequent cancer-related cause of death among HIV-infected persons. However, trends in presentation and survival have not been investigated among HIV-associated lymphoma patients in routine care since the beginning of the ART era.

Satish Gopal, M.D., M.P.H., from the Program in Global Oncology at the Lineberger Comprehensive Cancer Center of the University of North Carolina, and colleagues compared differences in presentation and survival, across histologic subtypes and diagnosis years, among HIV-infected lymphoma patients. They also examined predictors of death in this population. Data from 476 HIV-associated lymphoma patients living in the US who were diagnosed with various types of lymphoma including HL, diffuse large B-cell lymphoma (DLBCL), Burkitt lymphoma (BL), primary central nervous system lymphoma (PCNSL), and other types of NHL, between 1996 and 2010 were analyzed using various statistical methods.

Their results demonstrate that HIV-associated lymphoma is heterogeneous and changing since the ART era began. Clinical presentations across the different lymphoma subtypes was highly variable during the study period (79 HL, 201 DLBCL, 56 BL, 54 PCNSL, and 86 with other NHL). Histologic shifts in the proportion of BL vs other NHL subtypes is increasing consistent with other reports. Data showed that more recently diagnosed patients were older and more likely to be male, of nonwhite/nonblack ethnicity (primarily Latino patients), to be men who have sex with men, and to have prior AIDS-related illness. They were also more likely to be on ART at lymphoma diagnosis with higher CD4 counts and better HIV control. The authors also report that more recent diagnosis year was not associated with decreased mortality and that 61.6% of patients with HIV-associated HL were alive 5 years after lymphoma diagnosis, compared with 50.0% for BL, 44.1% for DLBCL, 43.3% for other NHL, and 22.8% for PCNSL. Of note, lymphomas occurring on ART were associated with a doubling of mortality, which may suggest important biologic differences between tumors developing on and off ART, although these results require confirmation.

Gopal and colleagues conclude, "These results highlight an ongoing need to elucidate lymphoma biology and optimize treatments for this challenging population to reduce deaths from one of the leading causes of mortality in the modern ART era."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our lymphoma / leukemia / myeloma section for the latest news on this subject.

In an accompanying editorial, Kieron Dunleavy, M.D., and Wyndham H. Wilson, M.D., Ph.D., from the Metabolism Branch of the Center for Cancer Research at the National Cancer Institute, state the findings reflect the shifting demographics of the HIV epidemic in the US. However, the shift towards more biologically favorable and curable types of lymphoma has not resulted in improved survival over the study period. They assert, "In conclusion, because HIV-associated lymphomas are potentially as curable as those arising in HIV-negative patients, it is critical that they be approached with the same care as HIV negative cases."

Journal of the National Cancer Institute

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New stem cell gene therapy gives hope to prevent Sanfilippo - an inherited neurological disease

Main Category: Neurology / Neuroscience
Also Included In: Stem Cell Research;  Genetics
Article Date: 25 Jul 2013 - 1:00 PDT Current ratings for:
New stem cell gene therapy gives hope to prevent Sanfilippo - an inherited neurological disease

Scientists from The University of Manchester have used stem cell gene therapy to treat a fatal genetic brain disease in mice for the first time.

The method was used to treat Sanfilippo - a fatal inherited condition which causes progressive dementia in children - but could also benefit several neurological, genetic diseases.

Researchers behind the study, published in the journal Molecular Therapy this month, are now hoping to bring a treatment to trial in patients within two years.

Sanfilippo, a currently untreatable mucopolysaccharide (MPS) disease, affects one in 89,000 children in the United Kingdom, with sufferers usually dying in their mid-twenties. It is caused by the lack of SGSH enzyme in the body which helps to breakdown and recycle long chain sugars, such as heparan sulphate (HS). Children with the condition build up and store excess HS throughout their body from birth which affects their brain and results in progressive dementia and hyperactivity, followed by losing the ability to walk and swallow.

Dr Brian Bigger, from the University of Manchester's Institute of Human Development who led the research, said bone marrow transplants had been used to correct similar HS storage diseases, such as Hurler syndrome, by transplanting normal cells with the missing enzyme but the technique did not work with Sanfilippo disease. This is because monocytes, a type of white blood cell, from the bone marrow, did not produce enough enzyme to correct the levels in the brain.

Dr Bigger said: "To increase SGSH enzyme from bone marrow transplants, and to target it to the cells that traffic into the brain, we have developed a stem cell gene therapy which overproduces the SGSH enzyme specifically in bone marrow white blood cells.

"We have shown that mice treated by this method produce five times the normal SGSH enzyme levels in the bone marrow and 11 per cent more compared to normal levels in the brain.

"The enzyme is taken up by affected brain cells and is enough to correct brain HS storage and neuro inflammation to near normal levels and completely corrects the hyperactive behaviour in mice with Sanfilippo.

"This is extremely exciting and could have huge implications for treatments. We now hope to work to a clinical trial in Manchester in 2015."

The University of Manchester team is now manufacturing a vector - a tool commonly used by molecular biologists to deliver genetic material into cells - for use in humans and hope to use this in a clinical trial with patients at Central Manchester University Hospital NHS Foundation Trust by 2015.

The stem cell gene therapy approach was recently shown by Italian scientists to improve conditions in patients with a similar genetic disease affecting the brain called metachromatic leukodystrophy, with results published in the journal Science earlier this month.

Manchester scientists refined the vector used by the Italian scientists. "This approach has the potential to treat several neurological genetic diseases," Dr Bigger added.

The research was funded by the UK MPS Society and the Sanfilippo Children's Research Foundation based in Canada.

Christine Lavery MBE, Chief Executive of the UK MPS Society, said: "Since 1970 over 130 children and young adults have lost their lives to Sanfilippo disease (MPS III) in the UK alone.

"Whilst new therapies for other MPS diseases are changing children's lives, parents of children with Sanfilippo disease can do no more than give the best possible care and live in hope that a treatment is around the corner. The positive results of Dr Brian Bigger's gene therapy programme in mice provides optimism for future generations of Sanfilippo children."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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The research is published in the journal Molecular Therapy this month.

The University of Manchester

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National Institute for Health and Care Excellence (NICE) recommends heat ablation therapy for patients with varicose veins, UK

Main Category: Vascular
Also Included In: Regulatory Affairs / Drug Approvals
Article Date: 24 Jul 2013 - 4:00 PDT Current ratings for:
National Institute for Health and Care Excellence (NICE) recommends heat ablation therapy for patients with varicose veins, UK

Covidien, a leading global provider of healthcare products, announced that a new guideline on the diagnosis and management of varicose veins has been issued today by the National Institute for Health and Care Excellence (NICE).[1] For the first time, NICE recommends heat ablation therapy as first line treatment instead of the more invasive surgical procedures currently being used.[1] This recognition signals a new era for the management of patients with varicose veins, who will benefit from a walk-in, walk-out procedure[2] requiring only local anaesthetic and allowing them to return to normal activities the next day.[3,4]

Varicose veins affect up to 3 in 10 adults in the UK5 and their impact on quality of life is comparable with that of congestive heart failure and chronic lung disease.[6] Additionally, the burden to the National Health Service (NHS) of managing the impact of untreated varicose veins such as leg ulcers is estimated at £1bn annually.[7]

"Patients with varicose veins are understandably reluctant to agree to invasive procedures that require significant recovery time and may need further intervention," said Mr Paul Flora, Vascular Surgeon, Barts Health NHS Trust. "The wider availability of heat ablation on the NHS is good news for these patients and has the potential to reduce the burden of managing the impact of venous ulcers."

Heat ablation is a cheaper therapy associated with less pain and quicker recovery times for patients, compared with traditional surgery such as 'vein stripping' or ligation.[1,4]

Access to appropriate treatment can transform patients' lives, as Dorothy Luke who was treated with radiofrequency heat ablation comments: "My varicose veins meant that I suffered a lot of pain and aching in my legs, which was really challenging because I'm on my feet all day. I was also embarrassed about the appearance of my legs. I didn't want to undergo a general anaesthetic so radiofrequency ablation was an ideal solution. I was delighted with the treatment: it was straight-forward, fast and virtually pain-free. I was able to return to normal activities immediately and the improvement has been dramatic."*

Within the heat ablation class of therapies, Venefit™ procedure using the ClosureFast™ catheter is the only one to use segmental radiofrequency ablation. Under ultrasound guidance, the catheter is inserted into the vein and directed to the area where treatment is required. The vein is heated, causing it to shrink and collapse, sealing the area around the varicose vein. Over time, the treated vein shrinks and is absorbed by the body. The procedure has been shown to cause less pain and bruising than conventional surgical treatments, with a faster return to normal activities and reduced risk of recurrence.[3,4]

"The Venefit procedure has been endorsed by the NHS Technology Adoption Centre (NTAC) providing safe and effective treatment for patients with varicose veins," said Mark A. Turco, MD, Chief Medical Officer, Vascular Therapies. "The move towards newer, more patient-friendly treatments demonstrating safety, clinical effectiveness and economic value is likely to improve treatment options for patients in the UK affected by varicose veins and we are delighted that NICE has chosen to recommend this procedure."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our vascular section for the latest news on this subject.

* Please note, this is the personal experience of this particular patient, and may not necessarily be representative of other patients’ experience.

[1] National Institute for Health and Care Excellence. The diagnosis and management of varicose veins. Clinical guideline. http://guidance.nice.org.uk/cg16826. July 2013.

[2] Nordon IM, et al. A prospective double-blind randomized controlled trial of radiofrequency versus laser treatment of the great saphenous vein in patients with varicose veins. Annals of Surgery. December 2011. 254(6): 876-881

[3] Almeida JI, et al. Radiofrequency ClosureFast versus Laser Ablation for the Treatment of Great Saphenous Reflux: a Multicenter, Single-Blinded, Randomized Study (Recovery study). JVIR; 2009; 20(6):752-9.

[4] Rasmussen LH, et al. Randomized Clinical Trial Comparing Endovenous Laser Ablation, Radiofrequency Ablation, Foam Sclerotherapy and Surgical Stripping for Great Saphenous Varicose veins. British Journal of Surgery. August 2011; 98(8):1079-87.

[5] Varicose Veins. NHS Choices. http://www.nhs.uk/Conditions/Varicose-veins/Pages/Whatarevaricoseveins.aspx. 20th August 2012 (Last accessed July 2013).

[6] Carradice D, et al. Modelling the effect of venous disease on quality of life.Br J Surg. 2011 Aug; 98(8): 1089-98

[7] Ruckley CV. Socioeconomic impact of chronic venous insufficiency and leg ulcers. Angiology. 1997; 48:67-9.

Covidien

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Withholding estrogen therapy cost tens of thousands of lives

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Academic Journal
Main Category: Women's Health / Gynecology
Also Included In: Menopause
Article Date: 20 Jul 2013 - 0:00 PDT Current ratings for:
Withholding estrogen therapy cost tens of thousands of lives

Nearly 50,000 women died unnecessarily over the last ten years because estrogen therapy was not given to patients aged 50 to 69 who had undergone a hysterectomy after the 2002 Women's Health Initiative (WHI) study.

In 2002, doctors and patients were seriously put off using HRT (hormone replacement therapy) because two trials - HERS and WHI - suggested that one type might raise the risk of cardiovascular problems. Up to that time, HRT had been seen as the savior for women who were in medical menopause; those who had undergone hysterectomy.

Dr. Philip Sarrel, emeritus professor in the Departments of Obstetrics, Gynecology & Reproductive Sciences, and Psychiatry, Yale University, and colleagues gathered and analyzed U.S. census data and hysterectomy rates, and estimated how much hormone replacement therapy had declined among female patients aged 50 to 59 between 2002 and 2011.

Before 2002, over 90% of these patients had been prescribed estrogen-only therapy for medical menopause symptoms, including hot flashes, as well as to prevent osteoporosis and other diseases caused by menopausal hormone deficiency.

Dr. Sarrel explained that the 2002 WHI study applied to women who took the combined estrogen plus progestin HRT - for patients with a uterus. Unfortunately, the study scared doctors away from any kind of HRT, including those who had undergone a hysterectomy.

Women who have a uterus (womb) are given the combination HRT because the progestin helps reduce the risk of cancer of the uterus.

Dr. Sarrel said:

"Sadly, the media, women, and health care providers did not appreciate the difference between the two kinds of hormone therapy," Sarrel said. "As a result, the use of all forms of FDA-approved menopausal hormone therapy declined precipitously."

The Yale researchers explained in the American Journal of Public Health (July 18th issue) that for those on the combined HRT, it was probably right to advise against taking it, because the WHI study demonstrated a heightened risk of blood clots, stroke, heart disease and breast cancer.

However, for the patients on just estrogen therapy, avoiding treatment appears to have been a bad decision that cost thousands of lives.

The second part of the WHI study, which focused on women who had had hysterectomies and compared estrogen-only patients with those on placebo, the results were quite different. Women on estrogen-only therapy had "mostly positive health outcomes", the authors wrote.

The WHI study in 2011 and 2012 found that over a ten-year period, fewer women on estrogen-only therapy died, or developed heart disease or breast cancer. The annual death rate over that decade for women not taking estrogen was 13 more per 10,000. The majority of them died from heart disease, while nearly half of the remainder died from breast cancer.

Dr. Sarrel said:

"Estrogen avoidance has resulted in a real cost in women's lives every year for the last 10 years - and the deaths continue. We hope this article will stir an overdue debate and raise consciousness about the health benefits of estrogen-only therapy for women in their 50s with no uterus."

In an Abstract in the journal, the authors wrote "Informed discussion between these women and their health care providers about the effects of ET is a matter of considerable urgency."

HRT has been a controversial subject for nearly a decade. Studies have produced conflicting results:

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