Posts Tagged Non-Hodgkin’s Lymphoma

Women’s Health in a Digital World  

At annual conference in San Francisco, a group of eminent panel members, discussed opportunities and challenges in women’s health.  Not only healthcare in general is undergoing a major transformation, but the panelists highlighted how the world of women’s health might also transform in the coming decade, as technology is increasingly used to address and bridge the gap that currently exists in women’s health and wellness.

Intel Health Guide remote monitoring system

Intel Health Guide remote monitoring system (Photo credit: connectologist)

Christina Resasco, Founder of Mobilize for Cure and Leukemia & Lymphoma Society’s 2013 “Woman of the Year” award winner, moderated the panel, and asked insightful questions.  Below are some highlights.

Robin Farmanfarmaian is a serial entrepreneur.  Hear early diagnosis and battling an auto immune disease, later gave her the inspiration and passion for health and wellness.  Farmanfarmaian has been a driving force behindSingularityUniversity’s highly successful FutureMed conferences.  Farmanfarmaian said, the practice of medicine will be completely disrupted in 2-5 years and will involve POC devices that will enable consumer to be a key decision maker; devices that will help in early diagnoses of several diseases taking the doctor out of it.

Fiona Ma, incumbent democratic candidate for State Board of Equalization, a reputed politician, and a former member of the San Francisco Board of Supervisors, California State Assembly.  She has long a standing interest in health and wellness and is a tireless campaigner and spokesperson for “San Francisco Hepatitis B Free” campaign.  Ma herself has battled Hepatitis virus.  According to Ma, technologies that help the efficient and seamless transition to EMR or electronic medical records, will be very important.  She also talked about how the government needs to find creative ways to work with the private sector, and not work in functional silos.  Her advice to women seeking to compete in the men’s world was to be proactive in taking on greater responsibilities and self selecting when required, rather than waiting for others to appoint them.

Panelist Danielle Posa was diagnosed with stage 3 Non-Hodgkins Lymphoma, at the age of 5 and learned early about the value and limitations of human life.  She campaigns and consults on health and wellness, and helps in fund raising efforts for Leukemia and Lymphoma societies.  Posa has been interviewed by Deepak Chopra on his show “One World” and has also spoken alongside him.  According to Posa, we need to integrate both the science and the art in implementing healthcare in the workplace.  She seeks to connect the public and the private sector leaders and help them broaden their focus from traditional metrics like GDP to more wholistic measures that reflect the quality of life.

Anne DeGheest ( ) founded Healthtech Capital and MedStars Venture Partners several years ago, with a mission to save lives, through utilization of technology.  She believes, we need to think outside the box to influence positive change in consumer behaviors, in order to disrupt healthcare.  She firmly believes that data for the sake of data does not do anything; instead technology focus will have to be on solving pain points.  She said entrepreneurs often neglect the market and focus on building prototypes or products.  She advised that instead the entrepreneurs focus on understanding the market and the value proposition they are offering, in to solve the pain points.  She said historically healthcare has been sold to men, but in many households, the “chief medical officer” at home, are moms.  One of the disruptions will occur on account of the wider role that pharmacy chains will likely play in healthcare, in future.  Most of the Americans live within 3 mile radius of pharmacy chains and these chains will step in to provide basic care.

Vanessa Mason serves as Senior Manager with eHealth and ZeroDivide.  She manages the project portfolio, contributing to design, development, and adoption of products and services that promote health equity.   With a strong focus on healthcare disparity and how that negatively impacts women,  Mason has sought to bridge the gap through efficient use of technology.  By some estimates, in certain geographical areas in the US, about 4 in 10 women, do not receive healthcare.  Rates of women without health insurance have been higher among African American women.  Some recent projects “text for wellness” and “mobilize”, focused on cardivascular health prevention for African-American women.  This was a great example of efficient use of technology that did not add to the costs, but effectively connected people to keep them informed and focused on meeting their wellness goals.  Often these women are pursuing career opportunities while single handedly taking care of families and have to navigate multiple worlds.  Technology can only help if it is easily accessible and affordable.  She advised entrepreneurs that they focus on enhancing quality of life of the 80% of population towards the bottom of the pyramid, where there are many gaps that also represent huge opportunities.




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Prognostic Biomarkers in Diffuse Large B-cell Lymphoma

Jason Yonehiro, founder and CEO of CombImmune Inc., talked about diagnostic biomarkers in lymphoma and their application in clinical utility and drug discovery, at event.

Non-Hodgkin’s Lymphoma refers to any of a large group of cancers of lymphocytes (white blood cells) and is often marked by lymph nodes that are larger than normal, accompanied by fever and weight loss.  They can be aggressive or fast growing and indolent or slow growing.  NHL is steadily growing over past few years.  While there were 115,000+ cases of NHL in 2002, worldwide, over 140,000 cases of NHL are anticipated in 2019.  NHL is more common in women.

Currently R-CHOP, a combination therapy that adds the drug Rituximab, a monoclonal antibody to standard combination called CHOP, consisting of four chemotherapy drugs, is considered a standard regimen for Diffuse Large B-Cell Lymphoma, the commonest type of NHL.  Bone marrow transplant is considered to be the second line of treatment.  Rituxan can lead to serious, including fatal, adverse effects and not all patients respond to this mode of treatment.  There is a significant unmet need for effective therapies for treatment of T-cell lymphomas, said Yonehiro.  There are several drugs in the pipeline.  Avastin failed in the trials, Revlimid is showing promise, but likely to be pushed further in treatment paradigm and Rituxan continues to remain gold standard in treatment.  Rituxan is not cheap.  A 28 day regimen with Revlimid, costs up to $10,000.  Rituxan is expected to come off patent and price may come down but its efficacy remains the same.

Thus far, it has been observed that Diffused Large B Cell Lymphoma (DLBCL) patients do poorly with the current standard of care, the R-Chop therapy.  But there do not exist any molecular diagnostic tests that predict patient outcome.  About 75% of patients respond to the standard of care but about 30-40% of patients relapse and die within 5 years.  The challenge is to identify high risk patients who might benefit from more aggressive chemotherapy.  It is important to minimize overtreatment of all patients, offer more treatment options, individualize treatment plans, identify high risk patients, make better clinical assignment, and optimize treatment.

Studies indicate that distinct patterns of chromosomnal abnormalities characterize NHL and there is need to better understand how these differences impact the response to certain therapies, said Yonehiro.  The field of personalized medicine is growing.  About $9.7B went into this area but this is expected to double by 2017.  The tool currently used is International Prognostic Index or IPI.  It is a clinical tool developed to aid in predicting the prognosis of patients with aggressive non-Hodgkin’s lymphoma.  In addition to the Ann Arbor Stage, IPI added certain other factors deemed significant, including age, elevated serum LDH, performance status, and number of extranodal sites of diseases.  However, this tool does a poor job, said Yonehiro.

CombImmune’s mission is to utilize prognostic and predictive biomarkers that enhance understanding of immune dysfunction to tumor infiltration and combine that with therapeutics that restore immune function and destruction of the tumor.  CombImmune prognostic test is based on Two Gene Score (TGS) to identify high risk patients.  TGS + IPI give a significantly more accurate patient profile, said Yonehiro.  Originally, they developed a 300 gene assay and now it is distilled down to 2 genes.  TGS has been vetted through study of 692 patients and there is an ongoing 215 patients prospective study.  TGS is based on PCR (Polymerase Chain Reaction) standardized molecular diagnostic genetic technique.

Genomic information is critical to improving management of hematologic cancers, said Yonehiro.  Two Gene Test, based on LMO2 and CD 137 expressions are robust independent prognostic determinants in DLBCL.  All studies thus far clearly indicate that TGS and IPI capture more high risk patients than IPI alone.  The clinical utility and value would be in its ability to pick out patients in need of more aggressive therapy, while others are put on “wait and watch” list.  The talk was followed by Q&A.

English: Micrograph of a diffuse large B cell ...

English: Micrograph of a diffuse large B cell lymphoma, abbreviated DLBCL. Lymph node FNA specimen. Field stain. See also Image:Large b cell lymphoma – cytology small.jpg (Photo credit: Wikipedia)

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