<The surprising answer is that these patients respond differently to treatment because, in fact, they are suffering from completely different types of lymphoma. Using what they dubbed a "Lymphochip," a customized Affymetrix DNA chip, Staudt and a group at Stanford led by
geneticist David Botstein discovered distinctive genetic differences between the cancers in the patients with large B-cell lymphoma who died and those who survived. "I was blown away by what we found," says Botstein. Effectively, they were looking at two different illnesses. "It's remarkable," says Staudt. "We found something in this disease that was missed for all the years pathologists were looking at it.">
I don't know what they found, but I know there is a mutation in the p53 gene which, if a diffuse, large, B-Cell Non-Hodgkins lymphoma patient has it, they are in big trouble. I think only 3% of them get to 5 year survival. Those people need some other treatment than the standard surgery, CHOP and radiation. Their health is badly damaged by the treatment, without the benefit of life-expectancy improvement.
Their numbers just go into the overall statistical pool which is used to decide the efficacy of treatment and prognosis.
Perhaps they are just talking about the same thing because for 3 years I've been ranting
Message 2824160
Message 2990164 that p53 tests need to be done using chip arrays [such as Affymetrix's] to see whether a person is in the 'game over' or 'good prospects' group.
I expect DNA microarrays to be big time. One thing I've learned is how very individual we all are. While particular cancers have broad similarities, we are each very individual in the precise nature of those cancers [lymphoma isn't just lymphoma - even within one person a particular cancer forms a multiplicity of cell-types, which might or might not react to a particular treatment, which is why cancers become immune to treatment].
Every cancer cell should ideally have it's own treatment. Not only that, but every person's circumstances are different. A very rich young person with a tough immune system is in a different position from a poor, old person with little holding them together. It's all very well to develop a treatment but not much use if few can afford it. So a range of treatments is needed.
The first thing needed is to define the range of cancer cells in each person. That takes DNA microarrays rather than gawping at the shape of cancer cells through a microscope. At present, because there are few treatments available, gawping is about as useful as DNA analysis. CHOP is all there is for a lot of lymphomas, so whatever the DNA array says, the treatment is the same.
As monoclonal antibodies and dendritic cell vaccines and other treatments develop, DNA analysis will become the means of knowing what to do.
Of course, somebody might come up with a smart way of fiddling with telomerase, curing all cancer! esculape.com Then the demand for DNA analysis would drop dramatically. Virtually all cancers have this telomerase problem, so we'd be back to [almost] universal treatment!
Mqurice
PS: I'm glad you are still posting and not on strike. I clicked on your name to see if you were posting and hey presto, here you were. |
