Anemic Patients With Myelodysplastic Syndromes Gain Long-Term Benefits From Erythropoietin and Myeloid Growth Factor Hormones

Myelodysplastic Syndromes (MDS), a group of blood disorders that can lead to acute myeloid leukemia (AML) in some patients, often cause severe anemia (when the body lacks a sufficient number of functional red blood cells). While certain treatments can help manage the symptoms of anemia, some studies have suggested that they may lead to complications.

Now a new study demonstrates that MDS patients with anemia may benefit from treatment with an erythropoietin (EPO)-based regimen plus supportive care without added complications as compared with those receiving supportive care alone. The study will appear in the September 17 issue of Blood, the official journal of the American Society of Hematology.

The phase III prospective, randomized trial, conducted by research teams of the Eastern Cooperative Oncology Group, was designed to evaluate the efficacy and safety of EPO with or without myeloid growth factor treatment (G-CSF, or granulocyte colony-stimulating factor) and supportive care (SC) with red blood cell transfusions for patients with early-stage MDS (n=53), in comparison to supportive care alone (n=57).

For the study, the researchers followed MDS treatment and dosing guidelines recommended by the National Comprehensive Cancer Network, which include managing anemia with erythropoiesis-stimulating agents (ESAs) such as EPO. EPO is a drug that imitates the action of the hormone erythropoietin, which stimulates the body to produce more red blood cells. Generally, therapy with G-CSF interacts with EPO treatment synergistically to improve erythroid (red blood cell) responses, especially in MDS patients that do not respond to EPO alone.

"EPO is a recommended treatment for MDS, but the combination with G-CSF and supportive care required comparative studies in this patient population," according to lead study author Peter Greenberg, MD, Professor of Medicine, Stanford University Cancer Center. "Our goal was to manage anemia while not increasing the risk of transformation to leukemia, and we undertook this study to understand if this combination might be successfully utilized in these patients."

The results of the study proved successful for this group of patients with lower-risk MDS and anemia. After the first course of therapy, 36 percent of patients in the EPO arm responded to treatment, compared with only 9.6 percent in the SC alone arm. After subsequent courses, 47 percent responded in the EPO arm. Researchers then followed both patient groups for a median of 5.8 years to determine their long-term response to treatment. Responders to EPO experienced increased survival in comparison to the non-responders (5.5 vs. 2.3 years) and significantly improved physical, emotional, and functional well-being, reduced fatigue, and improved overall quality of life.

The research team otherwise found no statistically significant differences in overall survival of patients between the EPO and SC arms (3.1 vs. 2.6 years) or the incidence of transformation to AML (7.5 vs. 10.5 percent of patients, respectively), suggesting long-term safety of the EPO treatment regimen.

The study results also indicated that the combination of EPO plus G-CSF was beneficial for patients who either did not respond initially to EPO or who experienced a delayed response. Furthermore, higher doses of EPO seemed to prove valuable for a proportion of patients who initially failed to respond. Importantly, the outcomes suggested long-term tolerance to the treatment combination, with a low overall incidence of adverse events. Specifically, the researchers found no significant treatment-related increase in incidence of either cardiovascular or thrombotic (clotting) events or transformation to AML in the patients who received EPO alone or with G-CSF, as compared with those in the SC arm.

Recently, the FDA has issued alerts regarding the use of ESAs, noting increased mortality, possible tumor promotion, and thromboembolic events that have been observed in some studies of non-MDS patients receiving ESAs. However, other studies of patients with solid tumors receiving chemotherapy did not demonstrate an adverse effect of ESAs on survival.

"We believe the data suggest that the negative effects of cytokines, like ESAs, demonstrated in some studies of other diseases may relate to biologic and clinical features or the specific treatments associated with the differing disorders studied," said Dr. Greenberg. "Findings from this study demonstrate the relative safety and efficacy of EPO plus G-CSF for treating anemic lower-risk MDS patients and may be considered as part of future treatment recommendations for the use of this class of therapies."

For Aditional Information

• Treatment of myelodysplastic syndromes patients with erythropoietin
  with or without granulocyte colony-stimulating factor: results of a
  prospective randomized phase III trial by the Eastern Cooperative
  Oncology Group (E1996), Blood First Edition Paper, prepublished online
  June 29, 2009
• American Society of Hematology/American Society of Clinical Oncology
  2007 Clinical Practice Guideline Update on the Use of Epoetin and
  Darbepoetin
• ASH Model Policy on Indications for ESA Treatment for Patients with MDS

Advisory Committee Recommends Randomized Trial to Support Proposed Indication for Clofarabine in Adult AML

The FDA’s Oncologic Drugs Advisory Committee voted 9 to 3 that a randomized, controlled trial is needed to support the currently proposed label expansion for clofarabine (Clolar® , Genzyme) in adult myeloid leukemia (AML). Clofarabine is currently approved as the standard of care for pediatric acute lymphoblastic leukemia (ALL) patients who have relapsed or have refractory disease after at least two prior regimens. The drug has an Orphan Drug designation.

The committee found that the single-arm clinical study results submitted to support the label expansion showed clofarabine was an active agent in acute AML patients, but concluded that a randomized clinical trial should be necessary to better interpret clofarabine’s efficacy and safety in the proposed patient population.

“I am happy that the three panel members who have significant experience in treating older adults with AML recognized the value of clofarabine in these patients and did not see the need for a randomized trial,” said Harry P. Erba, M.D., Ph.D., University of Michigan, one of the co-principal investigators of the CLASSIC II study.

“The panel indicated that it wasn’t an easy decision to vote for a randomized trial as Clolar was clearly active in these patients,” said Mark Enyedy, president of Genzyme Oncology and Multiple Sclerosis. “The requirement for a randomized control trial as a standard of evidence was a major focus of the discussion. We remain committed to the clinical development of Clolar in this patient population with high unmet medical need.”

Genzyme is conducting a randomized Phase 3 trial comparing clofarabine in combination with cytarabine to cytarabine alone in relapsed and refractory adult AML patients 55 years old or older. The trial continues to exceed patient accrual expectations, and results are expected in 2011. Clofarabine is also being investigated in clinical trials by most of the leading AML experts and major cooperative leukemia investigation groups in the United States and Europe.

The CLASSIC II study, discussed at the Oncologic Drugs Advisory Committee (ODAC), analyzed 112 adult AML patients aged 60 years and older with one or more unfavorable prognostic factors, including age 70 years or older, an antecedent hematologic disorder (AHD), poor performance status, or intermediate or unfavorable cytogenetics. As reported in peer-reviewed literature, and discussed by a separate panel of AML experts who recommended the trial, these risk factors predict poor outcomes in older patients with conventional induction therapy.

Patients in the trial had a 45.5 percent overall remission rate, including a 37.5 percent complete remission (CR) rate, and remission rates were consistent regardless of the type or number of unfavorable risk factors. The study also found that clofarabine remissions were durable. Durable CR is accepted as an established surrogate for clinical benefit in patients with acute leukemias. The median duration of remission in overall responders (CR+CR with incomplete platelet recovery) was estimated as 52 weeks (12 months). Most patients who responded to treatment achieved remission after one cycle.

The safety profile of clofarabine in the Phase 2 study was generally predictable and manageable. The all-cause induction 30-day mortality was 9.8 percent and was consistent regardless of the presence or number of unfavorable prognostic factors. The safety findings were consistent with those for the approved clofarabine pediatric ALL indication. The most commonly occurring adverse reactions included nausea, vomiting, diarrhea, febrile neutropenia, rash, headache, fever, fatigue, hypokalemia, pneumonia, anorexia, pruritus, increased liver transaminases, neutropenia, thrombocytopenia, mucosal inflammation.

The American Cancer Society estimates that approximately 12,810 people will be diagnosed with AML in the United States in 2009. About 70 percent of these patients will die from the disease, and almost all will be adults. The median age of a patient with AML is about 67 years. As an acute disease, AML progresses rapidly and is typically fatal within weeks or months if left untreated.

Escalated Dose-Intensified Combined Modality Treatment Shows Survival Benefit In Patients With Early Unfavourable Hodgekin Lymphoma

With more than 7,500 participants from more than 100 European and non-European countries in attendance, the 14th congress of the European Hematology Association (EHA), which was held in Berlin, Germany, from June 4 – 7, 2009, proved record-breaking. The delegates gathered in Berlin to share the most recent developments in hematological research and improvements in care.

The program included sessions on clinical and laboratory hematology and covered all the major hematological subspecialties, including hemato-oncology, red cell disorders, hemostasis, thrombosis, pediatric hematology and transfusion medicine.

The program featured a session, presented by Prof. Peter Borchmann on behalf of the German Hodgkin Study Group / GHSG (abstract number 0553) discussing an analysis of Dose-Intensified Combined Modality Treatment In Patients With Early Unfavourable Hodgekin Lymphoma (HL).

As a result of intensified medical research, Hodgkin's lymphoma has become one of the most curable tumors in adults. Today, about 80% - 90% of patients experience long-term disease free survival (DFS). This is mainly the result of numerous large clinical trials initiated by the German Hodgkin Study Group and other organizations, taking place since the late 1970's, using risk-adapted, highly effective therapy modalities. From the late '70s nearly 15,000 patients have been randomized and treated in these prospectively randomized trials.

Risk Groups
Patients with Hodgkin lymphoma are divided in three risk groups according to the initial staging and additional clinical risk factors: early favorable, early unfavorable and advanced-stage risk groups.

Abstract 0553 (Interim Analysis of the GHSG HD14 Trial for Patients With Early Unfavourable HL) compared the results of the arms of the GHSG HD14 trial. The rational of this trial was to improve the prognosis of patients with early unfavorable disease by comparing the old standard treatment, 4 courses of ABVD (adriamycin, bleomycin, vinblastine, and dacarbacine) followed by localized radiotherapy (30 Gy IF-RT), with a more intensive chemotherapy regimen consisting of 2 cycles of escalated BEACOPP (bleomycin, etoposide, adriamycin, cyclophosphamide, vincristine, procarbazine, and prednisone) followed by 2 cycles of ABVD and the same radiotherapy as in the standard arm.

Treatment-associated toxicities
A previous GHSG trial (GHSG HD11) compared 4 cycles of ABVD with BEACOPP, followed by either 30 or 20 Gy IF-RT. This trial showed no difference with respect to outcomes, and despite excellent initial remission rates, approximately 15% of patients with early unfavorable-stage HL relapsed within 5 years and another 5% suffered from progressive disease. Nevertheless, these good results of the GHSG trials are threatened by treatment-associated toxicities such as infertility, cardiopulmonary toxicity and secondary malignancies.

Improving trial results
The GHSG HD14 trial showed a significantly better outcome in terms of progression-free survival in the more intensive escalated BEACOPP regimen than the standard regimen of 4 cycles of ABVD in patients with early unfavorable Hodgkin's lymphoma (HL).
The study, conducted by the German Hodgkin Study Group (GHSG), included 1645 patients in 346 centres. These patients had early unfavorable Hodgkin's lymphoma, clinical stage 1 or 2 and risk factors, including large mediastinal mass, extranodal disease, high erythrocyte sedimentation rate, and 3 or more areas affected.

Interim analysis
After the third interim analysis with 1127 patients, researchers decided to terminate the GHSD HD14 trial early because of the significantly better outcome for patients treated with BEACOPP compared to ABVD. The interim results showed that progression free survival (PFS) was significantly better for patients treated with the hybrid regimen than for patients treated with 4 courses of ABVD. After 3 years, progression-free survival was observed in 97% of patients in the escalated BEACOPP group and 91% in the ABVD group.

Furthermore, the interim analysis showed freedom from treatment failure to be 95% in the escalated BEACOPP group versus 91% in the ABVD group. Overall, there were more patients with progressive disease, relapse and a higher mortality in those receiving 4 cycles of ABVD. These results prompted the GHSG to adopt a regimen of two cycles of escalated BEACOPP followed by two cycles of ABVD plus 30 Gy radiotherapy as the new standard treatment for patients with early unfavorable Hodgkin's lymphoma.

Escalated BEACOPP, compared to standard BEACOPP, uses a higher doses of etoposide (200 vs 100 mg/m2), doxorubicin (35 vs 25 mg/m2), cyclophosphamide (1200 vs 650 mg/m2), with added granulocyte colony-stimulating factor support. Combined with local irradiation, the escalated regimen showed superior disease control compared with ABVD. Patients experienced more hematological adverse events in the escalated BEACOPP group compared to the ABVD group. This included leukopenia (22% vs , including 81%), thrombocytopenia (<1%>

Predisposition to Myeloproliferative Neoplasms
An unrelated presentation by Prof. Nick Cross, Salisbury, United Kingdom, discussed research aimed to understand what causes a group of related conditions known collectively as myeloproliferative neoplasms (abstract number 0555).

Researchers have found a common genetic 'signature' that predisposes to these disorders. The predisposition is relatively subtle and so it cannot by itself be used to predict whether anyone will develop disease or not, but it is an important step towards understanding why some people get cancer and why others do not. In the future it is possible that the abnormality we have found might be combined with other genetic and environmental risk factors to enable much better predictions of disease susceptibility to be made.

Myeloproliferative neoplasms or MPNs are conditions of the blood that are related to leukemia but in effect they are a very mild form that resembles the first steps towards cancer. They are characterised by the overproduction of red and white blood cells, which increases the risk of strokes and heart attacks. Many cases of MPDs are caused by a mutation in a gene called JAK2. When the JAK2 gene has mutated, it sends abnormal messages to the blood stem cells to produce more and more blood cells.

Scientists have found that a particular region of chromosome 9 that carries the JAK2 gene is predisposed to acquiring mutations, but only in individuals with a particular genetic makeup. It is likely that this finding will lead to a much better understanding of how the JAK2 gene mutations happen and why they lead to an increased risk of someone developing an MPD.

The study, carried out at the Wessex Regional Genetics Laboratory in Salisbury and the University of Southampton, has proved that people carrying this mutation-prone region of DNA on chromosome 9 that includes the JAK2 gene have triple the risk of developing an MPD. The chromosome 9 variant is present in 40% of the population in the United Kingdom but only 1 in 20,000 people develop an MPD each year. Nonetheless, the new research has confirmed that the inheritance of this genetic variant can contribute to inherited susceptibility to develop an MPD.The study found that the link was especially strong in polycythaemia vera (PV), one of the main three MPDs.

Professor Nick Cross, from the University of Southampton (University RoadSouthampton SO17 1BJ, United Kingdom, Tel. +44 (0)23 8059 5000, Fax +44 (0)23 8059 3131) who led the research team, said: “This research provides strong evidence that at least half of the cases of PV diagnosed each year are linked to an inherited genetic variant on chromosome 9. Whilst this risk is still very small it nonetheless confirms that individual susceptibility to acquiring cancer-causing mutations is linked to genetic inheritance. Now that we have this evidence we can carry out studies to determine exactly how the variant contributes to this risk.”

Dr Shabih Syed, Scientific Director at UK-based Leukaemia Research who sponsored the reserach, adds: “This is a very important step forward in our knowledge of the causes of myeloproliferative disorders. It helps us to understand why some people might be predisposed to acquiring genetic mutations that lead to cancers.”

For more information:

• 14th Congress of the Europan Hematology Association (EHA): Presentations.
• Diehl V, Franklin J, Hasenclever D, Tesch H, Pfreundschuh M, et al. BEACOPP, a new dose-escalated and accelerated regimen, is at least as effective as COPP/ABVD in patients with advanced-stage Hodgkin's lymphoma: interim report from a trial of the German Hodgkin's Lymphoma Study Group Journal of Clinical Oncology. 1998 Vol 16, 3810-3821.
• Patrice Carde P, Cavalli F, Diehl V, Franklin J. Is escalated BEACOPP a standard therapy for advanced Hodgkin's disease? The Hematology Journal (2000) 1, 282 ± 290.
• Jones AV, Chase A, Silver RT, Oscier D, Zoi K, et al. JAK2 haplotype is a major risk factor for the development of myeloproliferative neoplasms. Nature Genetics 41, 446 - 449 (2009) Published online: 15 March 2009

Read these PubMed abstracts:

• Federico M, Luminari S, Iannitto E, Polimeno G, Marcheselli L, et al. ABVD compared with BEACOPP compared with CEC for the initial treatment of patients with advanced Hodgkin's lymphoma: results from the HD2000 Gruppo Italiano per lo Studio dei Linfomi Trial. J Clin Oncol. 2009 Feb 10;27(5):805-11. Epub 2009 Jan 5
• Bosetti C, Levi F, Ferlay J, Lucchini F, Negri E, La Vecchia C. The recent decline in mortality from Hodgkin lymphomas in central and eastern Europe. Ann Oncol. 2009 Apr;20(4):767-74. Epub 2008 Dec 16.
• Eich HT, Müller RP, Engenhart-Cabillic R, Lukas P, Schmidberger H, et al. Involved-node radiotherapy in early-stage Hodgkin's lymphoma. Definition and guidelines of the German Hodgkin Study Group (GHSG). Strahlenther Onkol. 2008 Aug;184(8):406-10.
• Ben Arush MW, Shafat I, Ben Barak A, Shalom RB, Vlodavsky E, Ilan N. Plasma heparanase as a significant marker of treatment response in children with Hodgkin lymphoma: pilot study. Pediatr Hematol Oncol. 2009 Jun;26(4):157-64.
• Gobbi PG, Valentino F, Danova M, Morabito F, Rovati B, et al. Bone marrow stem cell damage after three different chemotherapy regimens for advanced Hodgkin's lymphoma. Oncol Rep. 2009 Apr;21(4):1029-35.
• Wood AD, Chen E, Donaldson IJ, Hattangadi S, Burke KA, et al. Id1 promotes expansion and survival of primary erythroid cells and is a target of JAK2V617F-STAT5 signalling. Blood. 2009 Jul 1. [Epub ahead of print].
• Tefferi A, Thiele J, Vardiman JW. The 2008 World Health Organization classification system for myeloproliferative neoplasms: order out of chaos. Cancer. 2009 May 26. [Epub ahead of print]

What to tell your patients:

• US National Cancer Institute: Definition Hodgkin Lymphoma
• Mayo Clinic: Definition Hodgkin Lymphoma
• WikiPedia: Definition Hodgkin Lymphoma
• LymphomaInfo.Net: Definition Hodgkin Lymphoma
• The Leukemia & Lymphoma Society (USA): Definition Hodgekin Lymphoma
• SteadyHealth.com: Definition of Myeloproliferative Neoplasms.
• UptoDate for Patients: Overview of Myeloproliferative Neoplasms.

Illustrations courtesy of the European Hematology Association.

Upcoming Phoenix conference highlights 'molecular oncology' for oncologists and their patients

Physician-scientists from the Arizona based Translational Genomics Research Institute (TGen), a non-profit organization dedicated to conducting groundbreaking medical research in with life changing results, and Scottsdale Healthcare, a primary clinical research site for TGen in the Virginia G. Piper Cancer Center in Scottsdale, AZ, will present their latest findings and techniques at a national conference designed to provide cancer doctors with new treatments for their patients.

'Molecular Oncology: The Sixth Vital Sign, What Every Oncologist Should Know' is intended to help oncologists provide better diagnosis, early detection as well as drugs and other treatments that in some cases can slow the growth or even shrink tumors.

'Given the explosion of new information on the genetic and cellular features of malignancy, the modern oncologist must master the significance and application of cancer-related sciences,' said Dr. Ramesh K. Ramanathan, Medical Director of TGen Clinical Research Services at Scottsdale Healthcare, a partnership between TGen and Scottsdale Healthcare Corp.

Personalized Medicine
Beyond the five vital signs of pulse, respiration, temperature, blood pressure and pain, is a new sixth 'vital sign' – molecular therapeutics. This new 'vital sign' offers oncologists the opportunity to identify the causes of disease at the molecular level in order to provide the right drugs in the right amounts at the right times for the specific needs of individual patients. This new approach is becoming better known in health circles as personalized medicine or theragnostics.

However, the the concept that information about a patient's genotype or gene expression profile can be used to tailor medical care to an individual's needs requires understanding of the link between the mechanisms of action of novel therapeutics and specific tumor geneticts, thereby unifying molecular diagnostics and therapeutics.

Given the explosion of new information on the genetic and cellular features of malignancy and the rapidly growing armamentarium of targeted therapeutics, oncologists today must master the understanding, appreciate the significance and value the application of cancer-related basic and clinical sciences. 'This gap in knowledge and its application in clinical practice will be addressed in this conference,' Ramanathan explained.

Dr. Ramanathan is the co-program director of the conference, along with Dr. Daniel Von Hoff, TGen's Physician-In-Chief and the Chief Scientific Officer at TCRS. Both doctors conduct groundbreaking personalized-medicine research and clinical drug trials at TCRS in Scottsdale, and both are on the clinical faculty of the University of Arizona College of Medicine. Both will present at the conference.

Other TGen and Scottsdale Healthcare scientists scheduled to present include: Dr. Jeffrey Trent, TGen's President and Scientific Director; Dr. Raoul Tibes, Director of the Hematological Malignancies Program at TCRS and an Associate Investigator at TGen; Dr. Stephen P. Anthony, Chief Medical Officer of TGen Drug Development Services (TD2) and a Senior Investigator at TGen; Dr. John Carpten, Director of TGen’s Integrated Cancer Genomics Division and a Senior Investigator at TGen; and Gayle Jameson, M.S.N., Director of Supportive Care at TCRS and an Associate Investigator at TGen.

Target audience
Besides oncologists, the target audience includes all physicians and health professionals involved in caring for cancer patients, and researchers interested in new cancer diagnostics and therapeutics.

Key objectives of the conference include:

• Explaining the molecular and cellular features of malignancy in diagnostic and therapeutic approaches to the treatment of cancer, and identifying new diagnostic tools.
• Assessing the effects and early clinical results of new, targeted drug therapies on solid tumors and malignant blood cancers.
• Identifying new drug therapies that optimize treatment results and minimize side effects in specific biologic and clinical scenarios.
• Evaluating clinical trials and translational methods of care and their proper use in clinical decision-making and patient management.

The conference is sponsored by TGen, Scottsdale Healthcare's Virginia G. Piper Cancer Center and Physicians' Education Resource (PER) of Dallas. The conference is certified for Continuing Medical Education.

For more information:

• 'The Sixth Vital Sign' runs Jan. 22-24, 2009 at the Arizona Grand Resort.
• Personalized Medicine Coalition

Also read PubMed abstracts:

• Acharya CR, Hsu DS, Anders CK, Anguiano A, et al. Gene expression signatures, clinicopathological features, and individualized therapy in breast cancer. JAMA 2008 Apr 2;299(13):1574-87. Click here for a full text version of this article.
• Pene F, Courtine E, Cariou A, Mira JP. Toward theragnostics. Crit Care Med. 2009 Jan;37(1 Suppl):S50-8.

Novel Treatments Demonstrate Improvements in Overall Survival (OS) and Response Rates (RR) in Difficult to Treat forms of Leukaemia and Lymphoma

The use of dexamethasone early in the treatment of children with acute lymphoblastic leukemia (ALL), the most common type of childhood cancer, may help reduce the risk of relapse. This is the conclusion from study results presented during the 50th Annual Meeting of the American Society of Hematology (ASH) in San Francisco, CA (December 6 – 9)

Additional research featured during the annual meeting included: the potential role of a combination therapy regimen that includes rituximab as the new standard first-line therapy for the treatment of advanced chronic lymphocytic leukemia, the examination of pralatrexate or 10-propargyl-10-deazaaminopterin (PDX), for the treatment of peripheral T-cell lymphoma in the largest prospective study of this subset of patients, and the results of the first study examining a promising new molecular target for the treatment of B-cell non-Hodgkin lymphoma.

'By conducting ongoing research with new, investigational treatments as well as with different combinations of existing treatment options that have been used for years, we are working to improve the survival of our patients with leukemia and lymphoma,' explained Dr. Linda Burns, MD, Professor of Medicine, Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, MN. 'The research presented today showcases the great advances we are continuously making in treating various blood cancers.'

Leukemia and lymphoma are two of the most common blood cancers. Leukemias are categorized based on the speed at which the cancer grows – acute leukemias grow quickly while chronic leukemias develop at a slower rate. Leukemias also are categorized as lymphocytic or myelogenous depending on whether they affect lymphocytes (a type of white blood cell) or stem cells found in the bone marrow. According to the National Cancer Institute, each year there are approximately 44,000 new cases and 22,000 deaths associated with leukemia in the United States.

Lymphoma is cancer of the lymphatic system that begins with a change in the lymphocytes, impairing the ability of the body’s immune system to fight infection. Lymphomas are divided into two categories: Hodgkin lymphoma and non-Hodgkin lymphoma. Most non-Hodgkin lymphomas are B-cell lymphomas, which are further classified into 14 different sub-types based on the stage of cell development during which the B cell has been affected. The rest are T-cell lymphomas, which affect another type of white blood cell. There are approximately 66,000 new cases of lymphoma and nearly 20,000 deaths each year in the United States according to the National Cancer Institute.

Also read blog entry:

• Fostamatinib Disodium shows promise in the treatment of Diffuse Large B-Cell Lymphoma and Chronic Lymphocytic Leukemia
• Dexamethasone can Eliminate One-Third of All Relapses in Childhood Acute Lymphoblastic Leukemia
• New Drug Shows Promise in the Treatment of Patients With Relapsed or Refractory Peripheral T-Cell Lymphoma
• Immunochemotherapy with Fludarabine, Cyclophosphamide, and Rituximab Improves Response Rates and Progression-Free Survival of Previously Untreated Patients with Advanced Chronic Lymphocytic Leukemia.