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Is COVID-19 Vaccination Safe and Effective for DLBCL Patients?

Is COVID-19 Vaccination Safe and Effective for DLBCL Patients? from Patient Empowerment Network on Vimeo.

Is COVID-19 vaccination safe and effective for diffuse large B-cell lymphoma (DLBCL) patients? Dr. Jean Koff shares what’s currently known about COVID-19 vaccination for DLBCL patients and provides information about studies currently underway on immunocompromised patients.

Dr. Jean Koff is an Assistant Professor in the Department of Hematology and Oncology at Winship Cancer Institute at Emory University. Learn more about Dr. Koff, here.

See More From The Pro-Active DLBCL Patient Toolkit


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What Is Diffuse Large B-cell Lymphoma (DLBCL)?


Transcript:

Katherine Banwell:

A question that’s on many people’s minds right now is if the COVID 19 vaccination is safe and effective for people with DLBCL? 

Dr. Koff:

So, I don’t think we have any reason to believe that it’s not safe. We haven’t seen any signals that it is not safe. I think there are reasonable concerns that for patients who either have active lymphoma where the lymphoma may be impacting their immune system and the immune system’s ability to mount the response that you need to get immunity when you get vaccinated. But even more so patients who are receiving some sort of therapy, especially chemotherapy and immunotherapy. Those types of treatments actually may knock out the same normal bystander immune cells that help you mount that immune response when you get vaccinated.   

And so, the concern there is that in those individuals either with active DLBCL or who are receiving treatment for DLBCL, that their immune systems might be somewhat compromised and not able to mount as robust of an immune response when they get vaccinated. 

And by extension, the vaccine may not work as well to protect them against COVID as it would in somebody who doesn’t have a compromised immune system. But what I’m counseling my patients is that if they are not actively receiving treatment that impacts their immune system like chemo or immunotherapy, I am recommending that they go ahead and get the vaccine.  Because to me the risk of COVID and COVID-related complications is very high. And the risk of complications from the vaccination is very low. And the protection that it offers – while we are not sure the level of protection that it offers in these special cases, some protection, if it does offer it is better than no protection. And the risk of immunization is low. We are actually doing the studies now at Emory.  

In specifically lymphoma patients who get the COVID vaccine. Whether they have active lymphoma or getting treatment in lymphoma, we’re doing the studies now to take a look and see whether they’re able to adequately mount immune responses to the COVID vaccine. So, that we can better counsel our patients on how effective these vaccines will be.   

So, once we have more mature data from our studies and from other centers, similar studies, we’ll be able to better estimate what the chances that the vaccine will be protective for an individual patient.

Diffuse Large B-Cell Lymphoma (DLBCL) Treatment and Research News

Diffuse Large B-Cell Lymphoma (DLBCL) Treatment and Research News from Patient Empowerment Network on Vimeo.

What’s the latest diffuse large B-cell lymphoma (DLBCL) treatment and research news? Dr. Jean Koff explains study findings shared at the recent American Society of Clinical Oncology (ASCO) 2021 meeting and what they could mean for the future of DBCL treatments.

Dr. Jean Koff is an Assistant Professor in the Department of Hematology and Oncology at Winship Cancer Institute at Emory University. Learn more about Dr. Koff, here.

See More From The Pro-Active DLBCL Patient Toolkit


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What Is Diffuse Large B-cell Lymphoma (DLBCL)?


Transcript:

Katherine Banwell:

Cancer researchers came together recently to share findings at the annual American Society of Clinical Oncology meeting. Also known as ASCO. Are there highlights from the meeting that patients should know about?

Dr. Koff:

Well, I think at every meeting, there are lots of exciting updates to possible treatments for DLBCL. I think with the recent ASCO meeting, what a lot of researchers and clinicians are excited about are treatments in the relapse setting for DLBCL. So, there may be shifts where we are more likely to use immunotherapies known as CAR T-cells rather than what we have standardly used for patients who have relapsed after their frontline therapy.

So, that’s one of the exciting updates and we’re eager to see more details on this data. But one of the other exciting areas that we’re following closely in and ask were there several updates are a newer class of drugs, a type of immunotherapy known as fites. And these are immunotherapies that help to target the lymphoma by binding to a marker on the lymphoma tumor surface and recruiting your own immune system to attack the lymphoma. And so, we’re getting more results from clinical trials from lots of these types of agents that are showing very promising results in patients who have relapsed DLBCL.

Katherine Banwell:

What are you excited about when it comes to DLBCL research?

Dr. Koff:

So, I’m very excited about what we call precision medicine.

Which is matching a variety of treatments that we have to what is best for an individual patient. Based on the factors we talked about, like the patient level factors, but more importantly the tumor level factors. Things like gene abnormalities or even abnormalities in the patient’s immune system. We’re still in the infancy of really getting a good understanding of how these molecular factors might be matched to an ideal treatment. But that to me is really the future is matching these patients based on their tumor profiles with a treatment that is the most likely to control the lymphoma, get rid of the lymphoma and offer patients a cure.

Should DLBCL Patients Consider a Second Opinion?

Should DLBCL Patients Consider a Second Opinion? from Patient Empowerment Network on Vimeo.

 Should diffuse large B-cell lymphoma (DLBCL) patients consider a second opinion or consultation with a specialist? Dr. Jean Koff explains the benefits of a second opinion and how it could help provide improved care.

Dr. Jean Koff is an Assistant Professor in the Department of Hematology and Oncology at Winship Cancer Institute at Emory University. Learn more about Dr. Koff, here.

See More From The Pro-Active DLBCL Patient Toolkit


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What Is Diffuse Large B-cell Lymphoma (DLBCL)?


Transcript:

Katherine Banwell:

What’s your advice to patients who might feel like they’re hurting feelings by seeking a specialist or a second opinion?

Dr. Koff:

Yeah, I would put them at ease. I would say that the vast majority of doctors who refer their patients to me for a specialty opinion or a second opinion who are not specialists, they are happy to have a specialist weigh in and give some guidance and expertise on treatment. Because we all have the same goal, which is to give you the patient the best treatment that we know how to, the best recommendations for your particular disease.

The way I see co-managing a patient who has maybe a community physician that they started off seeing and someone like me, who they see as a second opinion is that I work with their local doctor as part of a team. And I think of us as both team members in treating their cancer.

And it has not been my experience that these doctors have their feelings hurt when a specialist is brought on. A lot of time it’s in fact the opposite that they are glad for the patient, that there is somebody who can help guide treatment decisions.

What Is Diffuse Large B-cell Lymphoma (DLBCL)?

What Is Diffuse Large B-cell Lymphoma (DLBCL)? from Patient Empowerment Network on Vimeo.

What is diffuse large B-cell lymphoma (DLBCL) exactly? Dr. Jean Koff shares information about this specific type of lymphoma and explains why subtypes of DLBCL are important in determining optimal therapy.

Dr. Jean Koff is an Assistant Professor in the Department of Hematology and Oncology at Winship Cancer Institute at Emory University. Learn more about Dr. Koff, here.

See More From The Pro-Active DLBCL Patient Toolkit


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Should DLBCL Patients Consider a Second Opinion?


Transcript:

Katherine Banwell:

Hello, I’m Katherine Banwell, your host for today’s program. Joining me is Dr. Jean Koff. Dr. Koff, would you introduce yourself?

Dr. Koff:

Hi, I’m Dr. Jean Koff. I’m a lymphoma specialist and clinical researcher at Winship Cancer Institute of Emory University.

Katherine Banwell:

Great. Thank you for joining us. Well, let’s start with a definition. What is diffuse large B-cell lymphoma?

Dr. Koff:

So, we may want to back up and actually define what lymphoma is, because that may be unfamiliar to patients who are just getting a new diagnosis. So, lymphoma is a pretty general term, but it refers to a cancer that arises from white blood cells called lymphocytes. And normally these lymphocytes are part of your immune system. Normally they help to fight infections and even tumors. But sometimes in some patients often for reasons we don’t fully understand these lymphocytes, these white blood cells, part of your normal immune system can grow out of control to the point that they become a cancer. And when they do that, that’s called a lymphoma.

So, diffuse large B-cell lymphoma or DLBCL, is the most common, aggressive form of lymphoma. And we call it aggressive because it tends to grow quickly, and it tends to cause problems quickly.

Katherine Banwell:

Are there subtypes?

Dr. Koff:

There are and there are several different ways that you can subdivide DLBCL. One of the most common ways that DLBCL researchers and clinicians think about it is breaking it up into ABC and GCB subtypes. And what these subtypes are, are reflections of how the tumor expresses different genes and that makes it potentially susceptible to different types of therapy. Although we’re still trying to figure out the best way to target these different subtypes. You can also divide DLBCL up by other genes that it may express.

Patients may be familiar with the term double hit lymphoma that refers to a large cell lymphoma that has re-arrangements of certain genes, mainly MYC and either BCL-2 or BCL-6.

And then, there are other definitions that we can apply to DLBCL based on where the lymphoma arises. So, as you can see, there are lots of nuances into subdividing, this disease. There are lots of different varieties, and there are lots of subtleties. But one of the main breakdowns is between ABC and GCB.

Expert Advice for Newly Diagnosed DLBCL Patients

Expert Advice for Newly Diagnosed DLBCL Patients from Patient Empowerment Network on Vimeo.

Dr. Jean Koff shares key advice and important steps for newly diagnosed diffuse large B-cell lymphoma (DLBCL) patients to take to optimize their care and explains how seeing a DLBCL specialist can make a difference. 

Dr. Jean Koff is an Assistant Professor in the Department of Hematology and Oncology at Winship Cancer Institute at Emory University. Learn more about Dr. Koff, here.

See More From The Pro-Active DLBCL Patient Toolkit


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Transcript:

Katherine Banwell:

What three key pieces of advice would you have for a patient who has just been diagnosed with DLBCL?

Dr. Koff:

So, my three key pieces of advice are ones that I would give to almost any patient with a blood cancer. The first is to make sure that you get a referral as soon as possible to a lymphoma specialist. The second is to bring a family member or multiple family members if you can to any appointment where you’re meeting with your cancer doctors.

And the third is to make sure that you make a list of questions that you want to ensure that you have answered for yourself before you go into these visits with your cancer providers. Because a diagnosis like this can often be overwhelming and there can be a lot of information that is given at the visit. And you want to make sure that when you’re at that visit, you have the questions that are important to you answered. A good way to do that is to make sure you have notes you can refer to, to make sure all of your questions getting answered.

Katherine Banwell:

Why is it important for a patient to see a DLBCL specialist?

Dr. Koff:

Well, something that’s very exciting about DLBCL is that the field is changing rapidly in terms of what treatments are available and what treatments are recommended. And a cancer doctor who is not only responsible for seeing lymphoma patients, but also has to keep up to date with all the other cancers that they see, including solid tumors.

It’s often very hard for them to really stay abreast of all these changes in the rapidly changing field. So, a lymphoma specialist is going to be up to date on the current recommended practices for DLBCL.

And they can also be better equipped to make very specific recommendations for workup and for treatment approach for your particular case, taking into consideration all of those nuances that we talked about earlier that may apply to a treatment in DLBCL. And then, lastly, those lymphoma specialists often have access to either specialized treatments that are only available at certain centers or clinical trials of new treatments that are not available anywhere where the clinical trial is not being conducted.

How Is Diffuse Large B-Cell Lymphoma (DLBCL) Treated?

How Is Diffuse Large B-Cell Lymphoma (DLBCL) Treated? from Patient Empowerment Network on Vimeo

How is diffuse large B-cell lymphoma (DLBCL) treated? Dr. Jean Koff shares insight about DLBCL treatment types, factors to consider in determining treatment options, reviews approaches for relapsed disease, and explains the role of clinical trials.

Dr. Jean Koff is an Assistant Professor in the Department of Hematology and Oncology at Winship Cancer Institute at Emory University. Learn more about Dr. Koff, here.

See More From The Pro-Active DLBCL Patient Toolkit


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Should DLBCL Patients Consider a Second Opinion?


Transcript:

Katherine Banwell:

In general, then Dr. Koff, how is DLBCL treated?

Dr. Koff:

So, in general for patients who are getting their first-line therapy, they will receive some sort of combination of chemotherapy and what we call immunotherapy. For the vast majority of patients who are young and otherwise, healthy this will be a combination chemotherapy regimen known as R-CHOP.

Which consists of three what I call conventional chemotherapy drugs, an immunotherapy called cyclophosphamide and a steroid known as prednisone.

Katherine Banwell:

What are the main factors you take into consideration before a treatment approaches decided on? You mentioned age, health.

Dr. Koff:

Yes. So, I divide it into three different categories. The first category is the patient. So, there are patient factors that determine what treatments the patient is able to tolerate. And some of the main factors you mentioned are items like age or what we call co-morbidities, which are other health problems that the patient may have. But there may be other factors as well.

If a patient is not able to take care of themselves very well, because they’re very ill or they’re very debilitated or they’re unable to receive certain treatments because they have social factors that keep them from coming to certain centers or from following-up with care. Those all fall under that patient-centered bracket.

The next factor that I consider are items related to the lymphoma itself. So, we’ve already mentioned factors like, expression of different genes or having certain gene abnormalities. Those may play a role in determining what treatment a patient gets. And then, the last big category is where the lymphoma is in the body. And this refers, generally if the lymphoma is only in one limited site. Then those patients may get fewer cycles of chemotherapy, less time in chemotherapy and may receive radiation as part of their frontline treatment.

Whereas patients who have disease in more than one site who are spread out across the body, make it more cycles of chemotherapy. But also there are patients who have lymphoma in certain sites that requires that we give additional treatment to make sure that the disease in those special sites is treated

Katherine Banwell:

Where do clinical trials fit in, Dr. Koff?

Dr. Koff:

So, our goal in treating diffuse Large B-cell lymphoma in the first-line setting in somebody who’s newly diagnosed in most patients, our goal is to cure. Meaning that we treat the patient with chemo immunotherapy. And our goal is that the lymphoma never comes back, goes away and never comes back. Unfortunately, as of today we’re not able to cure every single patient. And depending on what factors you have in your disease, your likelihood that you will be cured with that first-line therapy may be higher or lower.

But until we’re able to cure every single patient with our first-line therapy, there is definitely room for improvement. And that’s where clinical trials feature in. Because the way that we are able to tell whether new therapies or new approaches to therapies are improving upon our goal of curing or our goal of controlling the lymphoma. We need to test them very rigorously in clinical trials.

Katherine Banwell:

Of course. Now what about for patients with relapsed disease?

Dr. Koff:

So, there are several different approaches that we use to patients who have relapsed depending on a lot of different factors that may play into a particular case. I would argue that in this case, clinical trials are even more important.

Because although we can still treat with the goal of cure for a relapsed patients with DLBCL, the likelihood that somebody will be cured after they’ve received their frontline therapy goes down, regardless of the factors related to the case. And so, this is a setting where it’s even more important that we improve upon our current strategies of treatment and our current treatments that we have available in clinical trials again are the way that we move forward with this.

Confusing CLL Terms Defined

Confusing CLL Terms Defined from Patient Empowerment Network on Vimeo.

What is FISH testing? What is IGHV? Physician assistant Danielle Roberts explains the meaning of these often confusing terms and their role in disease monitoring and CLL treatment decisions.

Danielle Roberts is a physician assistant with the Bone Marrow Stem Cell Transplant (BMT) team at Winship Cancer Institute at Emory University. Learn more here.

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Transcript:

Danielle Roberts:    

So, a FISH test is a test from your either blood in your bloodstream or from your bone marrow biopsy. And it stands for florescence in situ hybridization. And this is a highly specific test that looks at the chromosomal changes with CLL. This can be done in the peripheral blood or in the bone marrow.

And it’s important to remember that when we consider genetic testing and CLL, we aren’t talking about inherited genes, but the abnormalities that occur within the CLL itself.

So, an IGHV test is a mutational test that stands for the immunoglobulin heavy-chain variable gene locus. This can also be done in the peripheral blood and the bone marrow biopsy. This test can help us determine treatment options as well as help with determining what high-risk features there are for your particular disease.

So, 17p deletion is the deletion of the long arm of chromosome 17. This can be seen at initial diagnosis or it can be acquired later on in disease progression. So, for all patients this is one of the more important tests that if you’re going to ask your doctor if you’ve had, you should ask at a diagnosis. If you’ve relapsed later on, you should ask again if that mutational status is being observed or checked in your follow-up testing.

17p deletion is something that can be acquired along the course of your disease progression. It is not always seen at initial diagnosis but can be acquired if you are relapsed or refractory. Therefore I recommend that every time you’re having peripheral blood for flow or if you’re having bone marrow biopsies, especially if it’s for treatment planning purposes, you should advocate to your physician team to make sure that this test is being performed as it will drive – or as it can drive treatment decision-making.

Practical Advice for Coping with a CLL Diagnosis: What’s Next?

Practical Advice for Coping with a CLL Diagnosis: What’s Next? from Patient Empowerment Network on Vimeo.

After receiving a diagnosis of chronic lymphocytic leukemia (CLL), patients can have a variety of concerns. Physician assistant Danielle Roberts shares her top three pieces of practical advice for patients to move forward. 

Danielle Roberts is a physician assistant with the Bone Marrow Stem Cell Transplant (BMT) team at Winship Cancer Institute at Emory University. Learn more here.

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Transcript:

Danielle Roberts:       

My recommendations if I could have three things that I would recommend all patients with CLL do, 1.) It would be to have your financial information kind of in line or know how to find that. Unfortunately, a lot of the medications that we use to treat disease are incredibly expensive. However, there are really good patient assistance programs out there. In order to be able to apply for patient assistance programs you do have to submit your financial information to them. So, I would really suggest that you have access or be able to know where to find that.

I would also really recommend you talk to your family members in so that they understand what’s – where you are with your treatment and what’s going on. As a physician’s assistant, one of the questions I generally get is when they bring in a family member or somebody who has not been along in their journey for their treatment, if they’re asking lots of questions, that was and kind of diagnosis. So, I encourage people to talk about that at the beginning, so everybody understands where they are and what the plan for the future is going to be.

And then the last thing that I always recommend to everybody is to understand that not one treatment is right for everybody. Understand that things are going to change and we’re all going to grow and we’re going to learn with the process. But if you don’t tell your healthcare team what’s going on, we can’t help you. And we say that there is no such thing as a bad question to us. You’re never bothering us. That’s what we’re here for. Rather you tell us, even if it may be something you feel is minor, ahead of time so that we can address it and work towards a solution, if there needs to be one.

Myeloma Targeted Therapy: Why Identifying Chromosomal Abnormalities is Key

Myeloma Targeted Therapy: Why Identifying Chromosomal Abnormalities is Key from Patient Empowerment Network on Vimeo.

Charise Gleason, a nurse practitioner, provides insight as to why identifying chromosomal abnormalities is essential when it comes to targeted therapy as a treatment choice for myeloma.

Charise Gleason is a nurse practitioner specializing in myeloma and serves as the Advanced Practice Provider Chief at Winship Cancer Institute of Emory University. Learn more about Charise, here.

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Essential Tests & Imaging After a Myeloma Diagnosis

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Transcript:

Charise:                       

So, testing for chromosome abnormalities or changes are important when it comes to targeted therapy.

And we used to think of this more in that relapse setting. But we also look at it upfront now, because it tells us more about the path of myeloma. And there are reasons to check throughout at relapse, again, to see if something’s changed. So, with targeted therapy, we can use the translocation (11;14), for instance.

Many patients have a translocation t(11;14). It’s not a high-risk feature. But we know on clinical trial we have a drug that we’re using called venetoclax that those patients can be very sensitive to.

And so, we’re looking at this not just in translocations but in sequencing for other abnormalities or gene mutations that can help guide us with these newer therapies. And you see that across all cancer types at this point. So, you can get very specific with a patient’s type of myeloma – that this drug is going to work better because you have this mutation.

So, we look at it upfront. It guides us for risk stratification: standard risk versus high risk. And then we look at it in that relapse setting. Do we have a drug or a clinical trial that this patient will respond better to because of those abnormalities?

When we’re risk stratifying, we know standard risk, medium risk, and high risk. Those are those translocations, those gene mutations, that we know about.

But newer testing, like sequencing, gives us a lot more mutations that we don’t even know what to do with them all yet.

We don’t necessarily have drugs for all of them, but it does help guide us down the road. So, right now some common are the translocations, but also deletion 17p, which we’ve known about for a while. But maybe you see a BRAF mutation, which you typically associate with other types of cancers, but we see that in myeloma as well.

So, it helps us look at is there a drug that our myeloma patient might benefit from because they have a BRAF mutation, for instance. 

Essential Imaging and Chromosome Tests after a Myeloma Diagnosis

Essential Imaging & Chromosome Tests After a Myeloma Diagnosis from Patient Empowerment Network on Vimeo.

Charise Gleason, a nurse practitioner, explains why tests such as bone marrow biopsy, FISH test and full-body imaging are considered essential for patients after a myeloma diagnosis.

Charise Gleason is a nurse practitioner specializing in myeloma and serves as the Advanced Practice Provider Chief at Winship Cancer Institute of Emory University. Learn more about Charise, here.

See More From INSIST! Myeloma

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Myeloma Targeted Therapy: Why Identifying Chromosomal Abnormalities is Key

Lab Tests in Myeloma: Key Results to Monitor

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Transcript:

Charise:                       

The essential testing that a myeloma patient should undergo following a diagnosis is – obviously, you’ve had those diagnostic test labs, the 24-hour urine, some scans, but the specific things that we need are a bone marrow biopsy.

That includes cytogenetics and FISH, and we can talk a little bit more about that. You also want full-body imaging. We used to always use a skeletal survey, which was an X-ray of the long bones. But, really, the standard of care now is a whole-body scan.

So, depending on what your oncologist or your institution has, that would be a full-body CT scan, a PET-CT scan, or a full-body MRI. So, one of those tests is recommended. It’s not unusual if you have a PET. Like our institution, we use PET-CT. So, for a newly diagnosed patient, we’re also going to get an MRI of the spine for a further snapshot.

What we’re looking for with a full-body imaging is we want to make sure that there aren’t any lytic lesions.

So, with an X-ray, you have to have about 30 percent bone loss before it’s going to show up on an X-ray. So, those traditional X-rays that we used to use could actually miss an active lesion. So, in that diagnosis, we want to know that there is no active myeloma. And those other scans are going to be more specific to that.

So, the cytogenetics of a bone marrow biopsy are going to tell us more about the biology of the disease. So, cytogenetics actually grows out the pairs of cells. And so, that’s why that portion of the test can take a while to get back.

At our institution, it can take two to three weeks, because you’re actually growing out those cells to look at the chromosomes. And remember these are chromosomes, or genes, of the plasma cells. And so, we’re looking for those abnormalities that might be present. So, you think about it more for the biology of the disease.

When we’re looking at FISH, we’re also looking… That test shows a little bit different. It comes back quicker. It shows two different phases of cell changes.

And so, it will tell us about chromosomes as well. But do you have any additional chromosomes – so, that would make it a hyperdiploid narrow. It tells us if there’s a loss of a chromosome – so, you’re missing one, a hypodiploid. It also tells us about translocations – so, when you’ve had a piece of a chromosome change and go to another cell. And so, that, for instance, would be like that translocation t(11;14) or translocation t(4;14). So, it’s essential to have that testing to tell us about that, because it helps guide treatment. And as we talk more about targeted therapy, these things really can come into play.