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Monthly Archives: December 2016

Bone marrow transplant survival more than doubles for young high-risk leukemia patients

Bone marrow transplant survival more than doubled in recent years for young, high-risk leukemia patients treated at St. Jude Children’s Research Hospital, with patients who lacked genetically matched donors recording the most significant gains. The results are believed to be the best ever reported for leukemia patients who underwent bone marrow transplantation. The findings are expected to make transplantation a treatment option for more children and adolescents with high-risk forms of acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) who lack genetically matched donors, either related or unrelated. The research appears in the July 14 edition of the scientific journal Blood.

“This study shows that transplantation offers real hope of survival to patients with high-risk leukemia that is not curable with intensive chemotherapy,” said Wing Leung, M.D., Ph.D., the study’s principal investigator and director of Bone Marrow Transplantation and Cellular Therapy at St. Jude. Leung linked the gains to advances in cancer treatment as well as improved infection control and more sophisticated donor selection.

Five years after transplantation, survival was 65 percent for the 37 St. Jude patients with high-risk ALL treated at the hospital between 2000 and 2007, compared to 28 percent for the 57 St. Jude ALL patients who underwent treatment between 1991 and 1999. ALL is the most common childhood cancer.

AML survival after transplantation rose from 34 percent for the 50 St. Jude patients treated between 1997 and 2002 to 74 percent for the 46 AML patients treated between 2002 and 2008.

During the same periods, there was an eight-fold reduction in infections, a four-fold drop in treatment-related toxicity and a 2.5-fold decrease in leukemia-related deaths. The overall survival gains coincided with an end to irradiation therapy for St. Jude leukemia patients, a treatment that is associated with a range of immediate and long-term side effects.

“We can now identify donors for virtually all pediatric patients who need transplant to cure their leukemia. Importantly, our transplanted patients not only have high cure rates but also excellent quality of life, resulting largely from advances in chemotherapy, donor selection and supportive care,” said Ching-Hon Pui, M.D., St. Jude Department of Oncology chair and the paper’s senior author.

Bone marrow transplantation involves destroying the patients’ own diseased blood-producing bone marrow and replacing it with hematopoietic cells from healthy donors. This study included three types of donors: genetically matched related donors; genetically matched unrelated donors; and partially genetically matched donors. Parents generally make up the third group, who are known as haploidentical donors.

The largest survival gains involved patients whose blood and immune systems were rebuilt with cells from haploidentical donors. Survival for these patients increased from 12 percent in earlier ALL and AML treatment eras to 88 percent in the most recent treatment era.

Historically, transplant patients fared best and suffered fewer complications when the donors were relatives who carried the same six proteins on their white blood cells. Known as HLA proteins, they serve as markers to help the immune system distinguish between an individual’s healthy tissue and diseased cells that should be eliminated.

St. Jude investigators pioneered the use of haploidentical transplants, demonstrating that careful matching of patients and donors and proper processing of the hematopoietic donor cells enhances the anti-cancer effect of transplantation without significantly increasing side effects. The process involves careful testing and HLA screening of potential donors to identify the one whose immune system is likely to mount the most aggressive attack against remaining leukemia cells using specialized immune cells known as natural killer cells. The odds of finding a good haploidentical donor are 70 to 80 percent, compared to about a 25 percent chance of having a matched sibling donor, Leung said. The likelihood of finding a genetically identical, unrelated donor ranges from about 60 to 90 percent depending on the patient’s race or ethnicity.

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Doctor Touts Gastric Bypass As Diabetes Cure

  With obesity at epidemic levels in the United States and type-2 diabetes among the fastest-growing epidemics in history, some people are suggesting a treatment that can help reverse the trend.

Professional musician and music therapist Steve Barrett is 90 pounds lighter these days.

“I was carrying around an extra 90 pounds of weight on my frame and that took its toll on me, physically and mentally,” Barrett said. “You’re getting depressed and out of breath all the time.”

Barrett had laparoscopic gastric bypass surgery, a procedure that’s also sometimes called stomach stapling. While he underwent a drastic physical transformation, he said his main motivation was to cure his diabetes.

“To know that a major disease is gone from my body, that’s a cure. A miracle cure, you could say,” he said.

Doctors who specialize in weight loss surgery said that is not an exaggeration.

New studies are confirming what surgeons like Dr. John Price of the St. Luke’s Center for Surgical Weight Loss have seen for years — that gastric bypass surgery can cure some cases of type-2 diabetes overnight.

“It’s as much or more of an epidemic as morbid obesity,” Price said. “And then, to have an operation that is curative in 90 percent , that’s just tremendous.”

Price said he hopes the success rate will lead to a change in guidelines. He said he would like to see the threshold of obesity be lowered so that more patients will qualify for the gastric bypass.

“We’re greatly improving or curing you from the majority of health problems you’re suffering from your state of morbid obesity,” Price said.

Barrett said the surgery isn’t a simple solution. It still requires a drastic lifestyle change and a commitment to follow healthy guidelines. Still, he said that is much better than battling obesity and diabetes.

“I feel like I’m a brand new person,” he said.

Price said about half the insurance companies will currently pay for the weight loss surgery. Some studies show that the procedure will pay for itself in 24 months, just from the reduction in medication costs.

Price said he’s not optimistic that medical or insurance guidelines to lower the threshold for coverage will change right away.

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Dying at Home Often Easier on Cancer Patients, Caregivers

For people with advanced cancer, dying at home rather than the hospital results in higher quality-of-life scores at the end of life, and may be easier on the patients’ caregivers as well.

A study published online Sept. 13 in the Journal of Clinical Oncology found that compared to people who died in intensive care units (ICU) or other areas of a hospital, when people died at home, their loved ones were less likely to develop post-traumatic stress disorder or prolonged grief disorder, marked by intense, disabling grief that goes on longer than six months.

“Where someone dies has important implications for those they leave behind,” said the study’s lead author, Dr. Alexi Wright, an instructor in medicine at Harvard Medical School and the Dana-Farber Cancer Institute in Boston.

“It’s really important for people to articulate what they want. Dying at home may improve your own quality of life before death and it may improve your loved ones’ grief after your death,” she noted.

While most cancer patients prefer to die at home, that’s not always what happens, according to background information in the study. More than one-third of cancer patients die in the hospital and 8 percent die in the intensive care unit. Almost one-quarter of Medicare costs stem from intensive care treatment during the last month of life, according to the study.

To get an idea of whether the location where death occurs is associated with a better quality of life for patients at the end of life, and whether or not the place of death affects caregivers, Wright and her colleagues recruited 342 terminal cancer patients and their primary caregivers.

The cancer patients were interviewed at the start of the study, which was a median time of about 4.5 months before they died. Their caregivers were also interviewed when the study began and then around two weeks after the death of their loved one to discuss the quality of life experienced by their loved one at the end of life. In addition, the bereaved caregivers were also interviewed 6 months later.

The researchers found that people who died in the ICU or other areas of the hospital had more physical and emotional distress at the end of their lives, and had a poorer quality of life, compared to those who died at home with hospice care.

And, those who died at home appeared to have more well-adjusted loved ones after the death, reported the study.

“The place of death and the amount of medical treatment received shaped the bereavement experience. There was a fivefold increase in post-traumatic stress disorder in people whose loved ones died in the ICU versus at home,” said Wright. “While people may think that dying at home might be more frightening for caregivers, it may ultimately help them heal.”

Wright’s group also found that the risk of prolonged grief disorder among those whose loved ones died in the hospital was much higher almost 22 percent compared to 5.2 percent among caregivers whose loved ones died with home hospice.

Wright said the differences may stem from the activities that may take place in the hospital or ICU before death, due to the frightening nature of aggressive lifesaving care, such as cardiopulmonary resuscitation or mechanical breathing devices.

“This study wasn’t surprising. If patients and family members are in a familiar and comfortable environment, they’ll likely have a better outcome in terms of quality of life,” said Dr. Steven Libutti, director of the Montefiore-Einstein Center for Cancer Care in New York City. “A clearly unanswered question, though, is how do we decide when we’ve reached the end of our likely successful therapies? When do you come to an acceptance that you’ve exhausted all reasonable possibilities and transition to end-of-life care?”

Other experts stress that quality of life is an essential measure.

“Making the quality of life better for a patient with a terminal diagnosis is often more valuable than attempting to get an extension of life at the cost of quality,” said Wright.

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Gene Therapy Corrected Rare Bleeding Disorder: Study

Using gene therapy, German researchers report that they managed to “correct” a malfunctioning gene responsible for Wiskott-Aldrich syndrome, a rare but devastating childhood disorder that leads to prolonged bleeding from even minor hits or scrapes, and also leaves these children vulnerable to certain cancers and dangerous infections.

However, one of the 10 kids in the study developed acute T-cell leukemia, apparently as a result of the viral vector that was used to insert the healthy gene. The boy is currently on chemotherapy, the study authors noted.

“This is a very good first step, but it’s a little scary and we need to move to safer vectors,” said Dr. Mary Ellen Conley, director of the Program in Genetic Immunodeficiencies at St. Jude Children’s Research Hospital in Memphis, Tenn.

“The study shows proof-of-principle that gene therapy with stem cells in a genetic disorder like this has strong potential,” added Paul Sanberg, a stem cell specialist who is director of the University of South Florida Center of Excellence for Aging and Brain Repair in Tampa.

Neither Conley nor Sanberg were involved in the study, which is scheduled to be presented Sunday at the annual meeting of the American Society of Hematology in Orlando, Fla.

According to Conley, children (mostly boys) with Wiskott-Aldrich syndrome (WAS) are born with an inherited genetic defect on the X chromosome that affects the number and size of platelets and makes the children remarkably susceptible to easy bleeding and infections, including different types of cancer.

Bone marrow transplants are the main treatment for the disorder which, if they succeed, basically cure the patient.

“They grow up, go to college and they cause problems,” said Conley. “But they’re not an easy group of patients to transplant.”

Even if a good match is found, transplant recipients can go on to have more problems with infections, such as graft-versus-host disease, in which the body basically rejects the foreign elements.

“One of the long-lasting complications is the kids couldn’t do this, they couldn’t do that, they see themselves as different,” Conley said. “Transplants are getting better but we need better therapy, there’s no question.”

In this study, the researchers inserted a healthy gene capable of producing WAS protein into hematopoietic stem cells (the “granddaddy” cells that give rise to different blood cells), then transferred these stem cells back into the patient using a viral vector. A viral vector is a virus that has been modified to deliver foreign genetic material into a cell.

In fact, the experiment was largely successful, with cells now able to produce WAS protein, resulting in increased platelet counts and improvement of some immune-system cells.

“This is a first step that says you can correct the disease but I think most people would look at it and say the risk of leukemia is something, and that, let’s see if we can avoid that,” said Conley, whose team at St. Jude is working on a therapy involving a different type of vector. “It’s a good start, but I think we have better things coming down the road.”

In other news from the conference, another group of German researchers have determined that people who donate peripheral blood stem cells or bone marrow to help save a life don’t face any heightened risk of cancer.

Previously there had been some concern that drugs needed to get the stem cells out of the bone marrow and into the bloodstream where they could be accessed might pose a risk of leukemia.

The study was based on questionnaires returned from more than 12,500 donors, which also showed the donors tended to be in good health and were willing to donate again.

Another study found that the drug rituximab (Rituxan), used to treat rheumatoid arthritis and forms of leukemia and lymphoma, could greatly reduce graft-versus-host disease in stem cell transplant recipients.

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Early Signs of Rheumatoid Arthritis

People with rheumatoid arthritis suffer from excruciating pain and swelling in the hands and feet. In addition, several symptoms might occur in early stages. Read on to learn some beginning signs of rheumatoid arthritis.

Rheumatoid Arthritis Overview

Arthritis means joint inflammation, while rheumatoid arthritis refers to a chronic inflammatory disorder in which inflammation occurs in the hands and feet leading to excruciating pain and swelling. This disease is progressive and damages the lining of joints and results in joint destruction and deformity. It is also an autoimmune disease in that antibodies, which should attack infections of the body, destroy the body tissues such as the ligaments, bone, and cartilage instead. Women are more likely to have the disease than men are, and it commonly starts between the ages of 40 and 60.

The cause of the disease is arguable. Some researchers have explained that the immune system is activated to damage the body’s tissues, resulting in the irritation in some other organs like the joints. Others have believed that the sufferer might get the disease because he or she has a family history of arthritis. In addition, smoking might boost the risk of the disease as well.

Recognizing the symptoms of rheumatoid arthritis enables you to detect this disorder in early stages. Those are various, depending on persons who suffer from the disease. The following are the beginning signs of rheumatoid arthritis that may occur:

Flu-Like Symptoms

The disease might affect your body with flu-like symptoms like fever, fatigue, muscle aches, loss of energy, and loss of appetite. Those symptoms can happen for years.

Intermittent Symptoms

Once inflammation takes place, swelling and joint pain arise. When the joint inflammation abates, pain disappears for a while, and you might feel quite well during this time. However, the disease starts again and pain comes back.

Inflamed Smaller Joints

The joints in your hands, wrists, feet, and ankles are prone to be affected. As the disease advances, it includes your jaw, neck, shoulders, elbows, hips, and knees. A symmetrical pattern commonly occurs in your body, affecting in the same joints. No wonder you find it painful when you try to wiggle your wrists and rotate your ankles.

Swelling and Pain

Swelling results from fluid that enters into the joint, making it swollen and puffy. Fluid occurs due to inflammation in the lining tissue of the joint. The typical characteristics of swollen tissues are red, tender, and painful in the joints. Swelling might be a factor of morning stiffness that happens for about an hour or less. Joint stiffness might develop after waking up in the morning or sitting. You find it difficult to move your body until you stretch up. You can see a reduction in the range of motion of affected joints.

Excruciating pain might develop from moving the joints in the finger, arm, or leg. Pain can also result from swelling or inflammation in the joint and adjacent tissues. The frequency of pain may vary among the affected persons.

Rheumatoid Nodules or Lumps

The pea-sized nodules or lumps often come up under the skin and are situated near the elbow and fingers. They can get easily infected, especially when frequent pressure occurs in some specific areas like the ankles.

Summary

From the abovementioned symptoms, we know that rheumatoid arthritis is a progressive disease that you should care about. It means the disease first affects the joints in your hands, wrist, feet, and ankles, then it advances to your jaw, neck, shoulder, elbows, hips, and knees. If so, it is highly recommended that you consult your doctor for treatment.

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Great Green Gift Guide (Part I)

Giving gifts is one of the greatest part of the holidays; who can deny how great it is to see someone you love opening up a carefully chosen gift just for them?Lucky for us, the Rainforest Alliance let us know about their top gifts for everyone on your list! Whether you’re choosing for your mom, significant other, or coworker, they’ve got it covered.

And stay tuned for our upcoming installments of Great Green Gifts for everyone on your list in 2010!

The Rainforest Alliance’s Green Gift Guide

With the holiday season fast approaching, it’s time to start looking for the perfect presents for your loved ones. The Rainforest Alliance Certified™ seal, the Rainforest Alliance Verified™ mark and the Forest Stewardship Council (FSC) logo are your assurance that goods and services are produced in a way that protect wildlife, water and soil, where workers and families benefit from good working and living conditions, decent wages, health care and education.

Check out our green gift guide for the environmentally savvy.

For him:

Give him the gift of music. Jack Johnson’s latest CD, To The Sea, is packaged with sustainable FSC certified paper.

For her:

Pamper her with a variety of Alba Botanicals skin and hair care products, made with Rainforest Alliance Certified Andiroba and Brazil Nut Oil.

For the kids:

Foster their creative spirit with an art easel by Eco Tots, made from FSC certified wood. Be sure to include FSC-certified paper, so that the kids can make art the sustainable way!

For the foodie:

You can’t go wrong with a basket of gourmet foods, including teas, coffees, chocolates and fruit! Choose products bearing the Rainforest Alliance Certified seal, which can be found in all major supermarkets and specialty retailers. Check out the special holiday coffees by Caribou Coffee, Reunion Island Coffee and Timothy’s Coffee!

For the traveler:

A fun-filled adventure is at your fingertips. Search SustainableTrip.org for eco-friendly hotels and lodges in Latin American and the Caribbean, where local communities are treated with dignity and cultures are respected. And, if you’re flying on American Airlines, British Airways, KLM Royal Dutch Airlines, Asiana Airline or Al Nippon Airways, enjoy the complimentary Rainforest Alliance Certified coffee served onboard.

For the person who has everything:

What do you get someone who has everything? A rainforest of course! Donate to Adopt-A-Rainforest to support conservation programs run by the Rainforest Alliance’s partner organizations in Latin America.

Need additional ideas?

Take the spirit of giving further this year. Shop for your holiday gifts at the Rainforest Alliance’s holiday auction and you’ll also be supporting sustainability! Hurry – Bidding closes December 10 at 1pm EST.

And don’t forget a gift membership to the Rainforest Alliance, a gift that gives back to the planet the whole year through. Season’s Greetings!

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