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Archive for November, 2011

New Targeted Lymphoma Treatment Available at The Nebraska Medical Center

First new Hodgkin’s Lymphoma treatment approved by the FDA since 1977

 

It had been more than three decades since the last time the Food and Drug Administration approved a new treatment for Hodgkin lymphoma. That changed in August of 2011 when Brentuximab vedotin, or SGN-35 as it is more commonly know, was approved.

 

For lymphoma patient Justin Dorn, the progress came just in time.

 

“I didn’t have a lot of options left for treatment,” said Dorn, 37 of Kearney, Neb.
    
Diagnosed with lymphoma in 2009, Dorn had already undergone a stem cell transplant at The Nebraska Medical Center. It’s a treatment that works for the vast majority of Hodgkin lymphoma patients. For Dorn, it did not.
    
The medical center was able to treat Dorn with SGN-35 in the spring as part of a clinical trial of the new drug.
    
“I don’t think I would have made it this far without the drug,” Dorn said.
    
“The types of patients who receive this basically have few other options,” said Julie Vose, MD, MBA, oncologist at The Nebraska Medical Center and chair of hematology/oncology at The University of Nebraska Medical Center.  “So this gives them other options to look potentially to other treatments in the future.”
    
The treatment is a monoclonal antibody with chemotherapy attached to it. It works by delivering the chemotherapy directly to the cancer cells and bypasses the normal, healthy cells. The targeted “smart bullet” approach lessens the side effects of the chemotherapy.  SGN-35 treatments are given intravenously once every three weeks.
    
“Unfortunately, it’s not a cure,” Dr. Vose said. “It’s a way to shrink the tumors and get the patient feeling better and lessen their symptoms.”
    
As one of the hospitals participating in the clinical trials for SGN-35, Nebraska Medical Center oncologists saw the promising results first hand: 73% of the patients had their tumors shrink or disappear.
    
“A response as high as 73% for a group of patients like that is nearly revolutionary,” said R. Gregory Bociek, MD, Justin Dorn’s oncologist at the medical center.
    
The idea of a “smart bullet” for cancer is being seen in other areas of cancer research and treatment.
    
“That’s really the theme right now,” Dr. Vose said. “We’re trying to attack just the tumor, not the normal tissue so we can reduce the side effects and have better anti-cancer effectiveness.”

 

Transplant Surgeons At The Nebraska Medical Center Use Revolutionary Technique In Performing Living Liver Transplants

Doctors say the procedure greatly increases safety, especially for the donor

 

For nearly two decades, Russ Hart knew his liver was failing. Doctors told him it was only a matter of time before the degenerative liver disease he had would precipitate the need for a transplant. “Fortunately, I made it much beyond the ten years they were predicting,” said the Manhattan, Kan. native. “I made it 18 years before I needed a transplant. And for most of those 18 years, I was very healthy.”

 

But the good health Hart enjoyed quickly came to an end. “I started to get quite jaundiced and yellow,” said Hart. “I was very tired and obviously was going downhill. I could hardly stand up at times. I just didn’t have the strength to do that.”

 

Hart got on the waiting list for a transplant. His wife, meanwhile, started spreading the word about the possibility of a living donor. “I wasn’t really interested in doing that because I didn’t want to put somebody else in harm’s way,” said Hart. “But the sicker I got, I realized that might be an opportunity for me to live.”    

 

Hart says a lot of people didn’t realize the liver is one of the few organs that has the unique ability to regenerate, so they didn’t know living donation was even an option. “The biggest question we always got was, ‘Can they do that? I didn’t know they could do that.’ So I explained at The Nebraska Medical Center they had a unique procedure where they took a quarter of the donor’s liver which made it much safer for the donors.”

 

Hart said it was this new procedure that prompted him to accept a donation from a member of his church that would eventually save his life. “There has always been something inside of me that’s pushed me to do something self-sacrificing in a big way,” said eventual donor Josh Nelson. “I trusted Russ that this was one of the best places in the world to get a transplant.”

 

There was another realization that prompted Hart to accept Nelson’s offer. “I realized if I accepted this gift from Josh, the liver I would’ve possibly gotten (from a cadaver) could go to someone else,” said Hart. “Another life would be saved in addition to mine, so really we got two great benefits out of the one gift Josh gave.”

 

“The need for living donation has arisen because of a shortage of cadaveric organs,” said Nebraska Medical Center liver transplant surgeon Jean Botha, MD. “About ten percent of our liver transplant patients will die every year because of a shortage of organs.”

 

Dr. Botha says this is where living donation attempts to fill the gap. “Historically speaking we’ve tended to take the larger portion of a donor’s liver, or their right side, for a living liver transplant. That takes between 60 to 65 percent of the donor’s liver mass to be able to provide enough functioning liver mass for the recipient.” But Dr. Botha says that method always placed much of the risk on the donor. “While that risk is low, it is still real.”

 

It was that risk, Dr. Botha said, that prompted transplant surgeons here to change their approach and change the way the operation was done. “We can now take a smaller piece from the donor,” said Dr. Botha. “That makes the operation safer for them, while still providing the recipient with the opportunity to get transplanted and to survive. So we are now taking the left lobe from the donor to be able to make it work in the recipient.”

 

“To be a leader in this field is very exciting,” said transplant surgeon Wendy Grant, MD. “If we can lead the way in donor safety, we think that’s a benefit to our patients and to the transplant community.”

 

When the time came for the transplant, Hart said he wasn’t fearful at all. “I knew I was in the best hands I could be in,” said Hart. “When I woke up, my wife immediately said my eyes were whiter. And that was the first time I knew things were going to work out.”

 

“I feel better than I have in years,” said Hart. “I wake up every morning and can see my wife and kids. I’m more thankful than I’ve ever been. I think about things in a different way.”

“The biggest thing I received,” said Nelson, “was the satisfaction of knowing that I did something to save someone’s life. If you didn’t take the chance, nothing happens. Nothing changes. But you’re taking that chance that you can change everything.”

 

“You’re basically dead, then you get a new life almost overnight,” said Hart. “It just takes your breath away.”

 

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