Got shingles and just toughing it out? Don't wait until postherpetic neuralgia sets in and regret it
Shingles – a name that may not be unfamiliar to many, and once it strikes, the excruciating pain can leave a lasting impression for life. The pain feels like being burned by flames, pricked by needles, or sliced by sharp blades, severely affecting the quality of life. It has many local names, such as "snake sore," "spider sore," and "snake coil sore," vividly depicting its appearance and the suffering it causes. If you have shingles, don’t tough it out. Pain specialists can help you avoid postherpetic neuralgia. Why is shingles so painful? The main pathological feature of shingles is the virus "invading" the nerve ganglia, causing nerve inflammation and swelling, which leads to intense nerve pain. This pain often begins before the rash appears or occurs simultaneously with the rash, presenting as a burning sensation, tingling, electric shock-like pain, or dull ache. For elderly or frail patients, the pain can be even more severe and last longer, significantly impairing the patient's quality of life. Shingles pain, don’t just endure it! Some people believe "the pain of shingles is temporary, and it will go away once the rash subsides!" However, in reality, while the rash may have a tendency to heal on its own, the pain does not. The pain originates from the damage caused by the shingles virus to the nerves, and this damage is persistent and difficult to repair on its own. Even if conventional treatments, such as antiviral therapy, are administered at the clinic, if the pain remains significant, it’s important to seek professional help from a pain specialist immediately. Delaying treatment and waiting for the pain to subside on its own will not only fail to resolve the issue but may also result in missing the optimal treatment window, leaving the pain to trouble the patient long-term. How does the pain specialist treat shingles? The treatment for shingles aims to relieve pain, shorten the duration of the rash, and prevent postherpetic neuralgia. Once shingles-related nerve pain occurs, early and standardized comprehensive treatment is crucial. Pain specialists offer a wide range of treatment options: ● Antiviral treatment, ideally used within 72 hours after the rash appears ● Pain relief medications, including nerve pain treatments ● Nerve block injections ● Nerve pulse radiofrequency therapy ● Spinal cord stimulation ● Peripheral nerve electrical stimulation ● Intrathecal drug analgesia ● Immunotherapy, etc. Avoid shingles, prevention is better than treatment For shingles, prevention is even more important than treatment. We can strengthen our defenses and stay away from shingles by doing the following: Adjusting lifestyle to boost immune function: Maintain sufficient sleep to allow the body to fully rest and repair at night; have a balanced diet to provide rich nutrients that support the body; engage in moderate exercise to enhance metabolism and immune function. 图片来源：pixabay Avoid excessive fatigue and mental stress In the fast-paced life, we are often overwhelmed by the pressures of work and daily life. However, excessive fatigue and mental stress are catalysts for shingles. It is important to learn to balance work and life, allowing enough time for rest and relaxation, so that the body and mind can fully unwind. This will effectively help prevent the occurrence of shingles. Vaccination: The "ultimate weapon" for prevention Vaccination is the "ultimate weapon" for preventing shingles. It creates a strong defense in our body, preventing the virus from invading easily. Especially for the elderly and those with weakened immune systems, vaccination is a key measure for preventing shingles. 图片来源：pixabay Although shingles is distressing, as long as we understand it, take preventive measures, and treat it properly, we can better avoid it! If you unfortunately develop shingles, it is recommended to visit the pain clinic promptly. In addition to basic medication treatments, pain clinics also offer specialized therapies that can quickly and effectively relieve pain and prevent or reduce the occurrence of post-herpetic neuralgia. Expert Introduction
2025-1-24
Keep this cancer-fighting 'prescription' and achieve better cancer-fighting results!
We often say 'illness is born from the mind.' When facing the threat of cancer, patients often experience a series of complex psychological reactions, among which anxiety and depression are the most common. These emotional responses not only affect the patient's quality of life but may also have an adverse impact on the treatment outcome. Therefore, recognizing the prevalence of these psychological states and their potential negative effects is crucial to improving the overall effectiveness of cancer treatment. 图片来源：pixabay Can negative emotions really affect cancer treatment outcomes? Scientific research has confirmed that long-term negative emotional states, such as depression, anxiety, and anger, can increase the risk of developing cancer and also have a negative impact on the treatment outcomes for cancer patients. When people face emotional stress, it may activate the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system, releasing hormones like corticosteroids and adrenaline. These hormones have an immunosuppressive effect, which inhibits the function of immune cells, weakening the body’s ability to monitor and eliminate cancer cells. For example, in lung cancer, a study published in Nature Medicine showed a close relationship between emotional stress and the effectiveness of immunotherapy for lung cancer. Among advanced non-small cell lung cancer patients receiving first-line immunotherapy, those experiencing emotional stress had a shorter median progression-free survival, lower objective response rates, and higher risks of disease-related death. This indicates that emotional stress not only affects the patient's quality of life but can also directly lead to resistance to lung cancer immunotherapy, reducing the effectiveness of treatment. Patients without emotional stress have a longer progression-free survival Therefore, the saying “illness originates from the mind” is not without reason. A good mental state has a positive impact on health, helping to reduce the risk of illness and aiding in recovery and prognosis. Mr. Zhao's Anti-Cancer Story: From Giving Up to Regaining Confidence Mr. Zhao is a patient in the Digestive Oncology Department of Beijing GoBroad Hospital. Eight months ago, he was diagnosed with stage IV colon cancer, with bone metastasis. During his first consultation, Mr. Zhao was in a depressed mood and even considered giving up treatment. However, with the professional and patient support of Dr. Lu Ming and his team, Mr. Zhao gradually regained his confidence. Throughout the treatment process, Dr. Lu Ming and the medical staff closely monitored Mr. Zhao’s physical and mental state. Whether adjusting treatment plans or answering questions, they gave their full attention and care. Encouraged by his doctors and family, Mr. Zhao set small goals for himself with each round of chemotherapy—aiming for progress with every treatment. The support and care from his family also served as a strong backbone, allowing him to hold onto the dream of returning to the marathon track. It is this positive and optimistic mindset that provided Mr. Zhao with powerful motivation in his fight against cancer. As we can see, psychological factors play an important role in cancer treatment and recovery! The following 3 methods can help patients maintain a healthy emotional state. A good mood leads to better cancer-fighting results! 01 Face cancer head-on, cancer ≠ deathFirst We need to face cancer realistically and break the misconception that “cancer = death.” Cancer is actually a type of disease that can be prevented, treated, and cured. With the continuous development of medical technology, more and more people are living with cancer. The anxiety and depression that many cancer patients experience largely stem from their lack of understanding of the disease. Therefore, gaining a deeper understanding of cancer, including treatment methods, prognosis, and so on, can help reduce fear and misconceptions about the disease, thus boosting their confidence and determination in treatment. 02 Turn big difficulties into small goals Set small goals: Break the treatment process into a series of small goals, and each time a small goal is achieved, you accumulate confidence. For example, set a goal to complete a certain rehabilitation task each day, or maintain good dietary and sleeping habits over a period of time. By continuously achieving these small goals, you gradually build the confidence to overcome the disease. 图片来源：pixabay 03 Shift emotional focus, release negative emotions After being diagnosed with cancer, patients can easily fall into fear and suffering from the disease. Learning how to shift and release negative emotions can effectively alleviate the fear and anxiety surrounding cancer. This can be done by recalling beautiful moments or successes, discovering personal strengths and advantages; or by engaging in entertainment activities to distract oneself, such as watching movies, listening to music, painting, etc.; it can also be done by directly venting, such as talking to a friend or writing a journal, releasing unpleasant feelings and experiences from the heart. 图片来源：pixabay Mental health plays a crucial role in cancer treatment. Through positive emotional regulation and psychological support, patients can not only improve their quality of life but also enhance their immunity, making treatment more effective. Overcoming fear, facing challenges, and filling the heart with hope, the future holds endless possibilities. Maintain a good mood, and the anti-cancer effects will be even better!
2025-1-24
China's Nuclear Medicine is Still in Its Early Stages: What Are the Key Challenges?
Introduction Nuclear medicine has reached a critical development juncture. The growth prospects have opened up a bright future, but there are still significant challenges to overcome. From the broad issue of how to break the monopoly on radionuclides, to the more specific questions of how to find the right clinical principal investigator (PI), how to establish nuclear medicine treatment wards, and how relevant departments can collaborate effectively—these are gaps that urgently need to be addressed. Beijing GoBroad Hospital, as a research-oriented hospital with strategic goals in difficult and critical disease diagnosis and treatment, clinical research, and biomedicine industry transformation, has always been dedicated to promoting medical technology innovation and advancement. Recently, Beijing GoBroad Hospital successfully passed the review and obtained the qualification to conduct clinical applications of Lutetium-177 [(177)Lu]. China has implemented strict regulations on the clinical application of nuclear medicine, with harsh approval conditions and a complex approval process. The hospital’s achievement marks an important step in advancing domestic nuclear medicine research and application. This also brings good news for patients with gastrointestinal, pancreatic, and neuroendocrine tumors in China. According to reports, a PRRT (peptide receptor radionuclide therapy) trial using Lutetium-177 for neuroendocrine tumors, led by Professor Lu Ming from Peking University Cancer Hospital and Beijing GoBroad Hospital, is currently underway. PRRT has become an essential treatment for neuroendocrine tumors. "The control time for this disease is far superior to all existing therapies, with very significant advantages," said Lu Ming, expressing great confidence and optimism. At this moment, the breakthrough clinical value of nuclear medicine is becoming a reality. In the past year, nuclear medicine has shown strong vitality and growth in the Chinese market, and the nuclear medicine industry has become a strategically supported emerging industry. However, for an emerging industry to transition from its initial stage to maturity, it must overcome various challenges. Currently, issues such as the domestic supply of radionuclides, transportation, and distribution remain unresolved. Midstream companies have not yet developed mature research and development capabilities or commercialization experience. At the downstream application level, the difficulty of coordinating multiple departments in hospitals is significant, and there is a limited number of treatment beds for nuclear medicine. For those in nuclear medicine research hospitals (which link upstream and reach patients), the "hands-on" experience is particularly profound. Recently, E-Pharma Manager visited Beijing GoBroad Hospital and conducted in-depth interviews with Professor Lu Ming from Peking University Cancer Hospital and Beijing GoBroad Hospital, and Dr. Du Rui, Medical Director of the Clinical Research Center at GoBroad. Standing from a professional perspective and drawing on personal experiences, they answered some key industry questions. • Why are there so few nuclear medicine research hospitals in China? What are the real challenges they face? • What are the key issues that need to be addressed for better development of nuclear medicine in China? The Overcrowding of Nuclear Medicine Treatment Hospitals Industry veterans are aware that nuclear medicine has a history of around 70 years, but 99% of this field is focused on diagnostic nuclear medicine, not therapeutic nuclear medicine. Over the past two years, two RDC products that have already been launched have exceeded commercial expectations, with Pluvicto now becoming a "billion-dollar molecule." As a result, the industry has seen a surge in RDC development, and nuclear medicine research and clinical applications are becoming increasingly "busy." During this period, many pharmaceutical companies, both domestic and biotech firms specializing in this field, have approached Professor Lu Ming’s team. Additionally, nuclear medicine investment and financing have been booming, with numerous favorable policies being introduced. While this vitality is undoubtedly a good thing, is the industry truly prepared across all fronts? One notable phenomenon is that “patients waiting for nuclear medicine treatment have a very high degree of acceptance and willingness, but many are still in the queue,” as Lu Ming deeply feels. There are two main reasons for this. One key reason is that hospitals, nuclear medicine treatment wards, and dedicated treatment beds are still limited. According to authoritative data, by the end of 2023, there were 1,237 departments (or divisions) engaged in nuclear medicine in China. Among these, 763 institutions provide radionuclide therapy, 709 of which have specialized outpatient clinics, and 389 have dedicated nuclear medicine treatment wards. Approximately 800 medical institutions offer radionuclide therapy, with 2,993 dedicated treatment beds available. Dr. Du Rui pointed out that several factors are restricting this situation. First, there are strict regulatory limitations. Environmental protection, health administration, and other relevant departments impose high requirements on the qualifications for radionuclide therapy, ward construction standards, equipment configuration, and personnel qualifications. As a result, the approval process is complex and stringent. “Hospitals must have complete qualifications, including radiation diagnosis licenses, radiation safety permits, and Good Clinical Practice (GCP) certification for nuclear medicine departments,” said Du Rui. Second, the construction costs are high. Building nuclear medicine treatment wards requires avoiding patient traffic and creating "isolated wards" to ensure "zero radiation" outside the ward. After treatment, patients need to stay briefly in the hospital to expel radioactive substances from their bodies. However, the number of nuclear medicine treatment wards and waste disposal systems in China is still developing and being improved. Additionally, the storage time for iodine-131 waste liquids has been extended from 10 half-lives to 180 days, requiring substantial space for decay pools and careful monitoring of environmental protection regulations. Third, there is a shortage of specialized doctors and skilled personnel. Authoritative data shows that by the end of 2023, China had more than 15,000 nuclear medicine professionals, with 6,748 being physicians, many of whom have diagnostic experience. “Radionuclide therapy involves multiple professional fields, including nuclear medicine, radiophysics, and radiobiology, and requires skilled medical personnel to operate and manage. However, there is still a relative scarcity of such multidisciplinary professionals in China.” Given the specialized and unique nature of nuclear medicine, the training cycle for such personnel is long and challenging. Fourth, there is insufficient collaboration among departments. In the past, the focus was mainly on diagnostic radiopharmaceuticals, but now more therapeutic drugs are under research. However, when implementing these projects, coordinating across departments such as radiology, nuclear medicine, and oncology presents significant challenges. Lu Ming remarked, “From the perspective of clinical doctors, we regularly face a wide variety of patients, with professional understanding of various diseases. We also have a clearer understanding of the benefits nuclear medicine treatments can bring to patients.” His team began exploring nuclear medicine therapy back in 2017, when the field wasn’t as developed as it is now. Over the years, the team has remained quite stable. "The diagnosis and treatment of neuroendocrine tumors is very specialized and requires a fixed multidisciplinary team. The team we’ve built has collaborated for many years. We have internal and external medicine doctors, including gastroenterology and hepatobiliary specialists, as well as experts in imaging, pathology, oncology, and more. We also have some of the country’s top nuclear medicine experts specializing in neuroendocrine tumors. Furthermore, we are one of the earliest teams in China to explore nuclear medicine therapy for neuroendocrine tumors. Our years of experience in collaboration allow us to have a clearer vision of the future and ensure more efficient clinical trials for nuclear medicine.” Therefore, the progress made by nuclear medicine research hospitals such as Beijing GoBroad Hospital is an important force in driving the development of nuclear medicine in China. In 2023, Beijing GoBroad Hospital officially began operations. In April, it established a specialist medical alliance with Peking University Cancer Hospital, focusing on the development of key departments, talent cultivation, and scientific research collaboration in fields such as digestive tumors. In September, multiple PRRT (Peptide Receptor Radionuclide Therapy) projects for neuroendocrine tumors, conducted by Peking University Cancer Hospital and Beijing GoBroad Hospital, were launched. In November, Beijing GoBroad Hospital obtained the qualification for clinical application of Lutetium-177 radionuclide. In terms of radiation protection, Beijing GoBroad Hospital has implemented strict radiation shielding measures and conducted professional radiation safety analyses for the Lutetium-177-specific treatment wards to ensure that the surrounding dose equivalent meets radiation safety requirements. The hospital also has a dedicated radiation safety and environmental protection management organization responsible for comprehensive radiation safety management and supervision. Currently, Beijing GoBroad Hospital has four radionuclide treatment wards, and it can provide treatment for 200 patients annually. When asked about the advantages of Beijing GoBroad Hospital in conducting nuclear medicine clinical research, Dr. Du Rui highlighted two main points. On the one hand, the hospital implements a "dual PI" model with both nuclear medicine specialists and clinical experts serving as co-principal investigators for nuclear medicine clinical research. This model reduces the excessive functions and burdens of a single PI in the traditional setup, while leveraging the respective professional strengths of both sides, which facilitates interdisciplinary collaboration and the generation of scientific research outcomes. On the other hand, the clinical departments' collaboration with Peking University Cancer Hospital provides abundant patient and clinical resources. In recent years, Professor Lu Ming's multidisciplinary team has not only strengthened clinical advantages but also gradually broken down disciplinary barriers, innovating research models and forming a "main force" in the exploration of nuclear medicine treatments, characterized by early development, broad exploration of radionuclides, high research and development efficiency, and clear technical advantages. The platform and advantages provided by Beijing GoBroad Hospital also serve as the "core" support behind the high efficiency of the PRRT project led by Professor Lu Ming, which is expected to be launched in 2024 and completed by the first half of 2025. Looking back at the issue of patients "waiting in line" for nuclear medicine treatment, another key reason, in addition to hospital and ward limitations, is that nuclear medicine resources are simply "not enough." Supply Chain Obstacles, R&D Entering the "Race"? "China’s domestic nuclear medicine production capacity is low and heavily reliant on imports," said Lu Ming. "Although the country now has the necessary reactor designs, testing, and operational foundations for producing radioactive isotopes, it has not yet developed large-scale production capacity." Previously, some interviewees explained to E-Pharma Manager that the mainstream domestic research on beta isotopes, such as Lutetium-177, is 95% imported, while isotopes like Molybdenum-99, Iodine-125, Carbon-14, Strontium-90/Yttrium-90 are all reliant on imports. At the same time, there is a high demand for medical isotopes in China, with a high annual growth rate, but there is a severe lack of domestic supply, creating a large gap, and in the buying and selling relationship, China is in a relatively weak position. Additionally, nuclear medicine isotopes have a short half-life, with some having a half-life of only a few hours. This makes it impossible to produce them in bulk in advance. The preparation and administration time must be very precise, placing extremely high demands on the production and distribution of radioactive isotopes and finished pharmaceuticals. Only entities with transportation qualifications can deliver them, making the process costly. "The treatment process is also quite complicated. Once the treatment plan is determined, the medication needs to be prepared abroad and shipped to China, a process that takes more than two weeks and is fraught with uncertainties." Moreover, the total amount of radioactive isotopes allocated to hospitals in China is usually limited. Once transported from abroad, it must be quickly delivered to patients. "It becomes a race—if you don’t manage to secure it, you’re left waiting in line." The Issue of Radionuclide Production Capacity Also Directly Affects Costs. "Currently, the cost of nuclear medicine treatment is quite high. On average, one treatment in China costs about 100,000 yuan, and a patient typically requires 4 to 5 treatments." Nuclear medicine therapy, following radiation therapy, chemotherapy, targeted therapy, and immunotherapy, provides an effective "weapon" for extending the life cycle of patients with advanced cancer. The global nuclear medicine market is expected to accelerate from $8.4 billion in 2023 to $29.4 billion by 2030, with a compound annual growth rate (CAGR) of 20%. The scale of the nuclear medicine market in China is also expected to grow from 7.8 billion yuan in 2023 to 26 billion yuan by 2030. Nuclear medicine treatments are beginning to "emerge" in multiple disease fields, particularly showing positive results in neuroendocrine tumors and prostate cancer. In April this year, the research teams from the Gastrointestinal Oncology Department and the Nuclear Medicine Department at Peking University Cancer Hospital published the results of a prospective Phase II clinical study on 177Lu-DOTATATE (Lutathera) in Chinese patients with advanced gastrointestinal pancreatic neuroendocrine tumors (GEP-NET). The study demonstrated excellent treatment effects and good safety. This offers a promising treatment option for patients with rare tumors in China, with the potential to significantly improve their quality of life and extend survival. Lu Ming firmly believes that RDC (Receptor-Targeted Radionuclide Therapy) is likely to become the standard first-line treatment for neuroendocrine tumors and may even become the primary treatment method for the disease in the future. In addition to neuroendocrine tumors, both Lu Ming and Du Rui see potential for nuclear medicine in other disease areas, such as prostate cancer. "Theoretically, what ADC (Antibody-Drug Conjugates) is doing now, we can achieve as well, and even extend beyond its application scope." "China’s clinical trial process for nuclear medicine is not a problem, and its efficiency is even higher than overseas," they said. However, at the same time, both Lu Ming and Du Rui believe that to further explore nuclear medicine applications, some practical issues still need to be addressed: The development of radionuclides is relatively concentrated, with β-radionuclides represented by Lutetium-177 (177Lu) and α-radionuclides represented by Actinium-225 (Ac-225). Target indications are concentrated. In Du Rui's view, the biggest pain point in China’s nuclear medicine research and development is the lack of new targets. About 70% to 80% of the clinical trials for nuclear medicine in China, as well as in Europe and the United States, focus on targets such as PSMA (Prostate-Specific Membrane Antigen) and SSTR (Somatostatin Receptor). Targeting ligands are nearly identical. In theory, RDC (Receptor-Targeted Radionuclide Therapy) has a broad scope and can be divided into antibody-conjugated radionuclide drugs (ARC), small-molecule-conjugated radionuclide drugs, and peptide-conjugated radionuclide drugs (PRC). However, with Novartis leading with two drugs in the field, most of the pipelines currently in development are peptide-conjugated radionuclide drugs. Overall, the market for existing nuclear medicine products is becoming saturated, and new products are needed to break through the market size, but there is still a lack of products capable of breaking the competitive landscape. To solve these key issues, both Lu Ming and Du Rui believe that it is necessary to strengthen basic research and early preclinical studies. There is a need for differentiated, breakthrough innovation in areas such as identifying new targets, developing novel radionuclides, advancing indications, and exploring different targeting ligands. However, currently, "basic research is relatively weak, original contributions are insufficient, and the ability to create unique, innovative solutions is not yet strong." Content source | E-Pharma Manager
2025-1-24
Expert Guest Room | Professor Pan Jing: The Application of CAR-T Therapy in R/R T-ALL and B-ALL, Discussing Prognostic Factor Analysis and CAR-T Stratified Treatment System
From December 7–10, 2024, the 66th Annual Meeting of the American Society of Hematology (ASH) was held in San Diego, USA. As the largest and most comprehensive international academic conference in the field of hematology, it annually attracts numerous hematology experts and scholars from around the world to gather and engage in in-depth discussions and exchanges on major research advancements in hematology. At this year's conference, the research findings of Professor Pan Jing's team from Beijing Gaobo Hospital garnered significant attention. Two CAR-T therapy-related studies (Abstracts 964 and 3466) were selected for the conference, bringing forward many advancements. To gain a deeper understanding of these groundbreaking research findings, Tumor Outlook - Hematology News conducted a live interview with Professor Pan, focusing on these two studies and CAR-T therapy. Below is a summary of the research and interview content. Hematology News Q1: When CAR-T therapy was first introduced, it was regarded as a potential cure for diseases. After years of in-depth exploration, do you think the role of CAR-T therapy in hematologic cancer treatment has changed? Professor Pan Jing: The therapeutic role of CAR-T cell therapy in hematologic malignancies has become increasingly solid. With the explosive growth of CAR-T products and clinical research advancements in recent years, CAR-T cell therapy is undoubtedly becoming more well-known. Although the progress in the CAR-T field has slowed down somewhat recently, at the just-concluded ASH meeting, there were significant updates on the cutting-edge advancements in CAR-T therapy, with some foundational and translational medicine research data being presented, showing promising prospects and hope. There is no doubt that CAR-T therapy is now recognized as a solution to some of the more challenging treatment issues in the hematology field, and its therapeutic position is becoming more important and stable. Its development relies on the overall integration of basic medicine, translational medicine, and clinical medicine. Q2: Your research team has been continuously exploring CD7 CAR-T therapy in T-cell tumors. This year, your research was also selected for the ASH meeting. From the perspective of the researchers, what is the clinical value of this study? Professor Pan Jing: In fact, at international academic conferences such as ASH and EHA, our team primarily reports the latest results of a series of studies. At this year's ASH meeting, our team presented two major areas of progress: In T-cell tumors, we analyzed survival prognostic factors in 75 patients who received CD7 CAR-T cell therapy for relapsed/refractory (R/R) T-ALL. In the B-cell tumor field, for patients with large central masses or high central tumor burden, our team is exploring the use of intrathecal CAR-T therapy, aiming to address some of the more challenging treatment issues in the hematology field. Q3: At this year's ASH, your team presented a study on intrathecal infusion of CD19/CD22 CAR-T cells for treating CNS leukemia or relapsed/refractory (R/R) B-ALL patients with high central nervous system relapse risk. How do you view the value of CAR-T stratified treatment? Professor Pan Jing: The CAR-T stratified treatment approach for B-cell acute lymphoblastic leukemia (B-ALL) is becoming increasingly clear, and the stratification factors are more defined. This is the result of nearly ten years of global CAR-T treatment practice data. Some studies presented at last year's ASH and this year's EHA meetings have already demonstrated the clinical value of the CAR-T stratified treatment system. In this system, correctly identifying high-risk relapse patients who need CAR-T therapy and then bridging them to allogeneic hematopoietic stem cell transplantation (allo-HSCT) is of great significance. In fact, our center proposed the concept of CAR-T stratified treatment early on, where some B-ALL patients could achieve a cure with CAR-T therapy, while others with high-risk relapse would need rapid bridging to allo-HSCT to improve survival. This stratified treatment system has been consistently followed and implemented. Relevant research data were published in BLOOD (Phase I study data from 2017-2018) and The Lancet Oncology (Phase II study data from 2019). For patients with central nervous system leukemia (CNSL), a sub-group of relapsed B-ALL, we have attempted intrathecal CAR-T therapy and explored the safety and timing of this treatment. Currently, we believe that administering CAR-T intrathecal injection after cytokine release syndrome (CRS) resolves is safe and manageable. Q4: What is the future outlook for CAR-T therapy in China? Professor Pan Jing: Some experts believe that China's CAR-T clinical research is already leading the world. First, Chinese researchers have rich clinical experience, and the patient population is larger, with a clinical trial management system that differs from that of other countries, giving China an advantage in CAR-T clinical research. However, it is also important to note that China has some weaknesses in basic scientific research and translational medicine, which are critical for providing pioneering ideas and breakthrough directions. In this regard, we are relatively behind, but we hope to "catch up" by integrating basic medicine with clinical research. Abstract 964丨CD7 CAR-T-cell Therapy in Relapsed or Refractory T-cell Acute Lymphoblastic Leukemia-a Retrospective Study Research Content A retrospective study of patients with relapsed/refractory acute T-cell lymphoblastic leukemia (R/R T-ALL) treated with CD7 CAR-T cell therapy. Abstract 964: CD7 CAR-T-cell Therapy in Relapsed or Refractory T-cell Acute Lymphoblastic Leukemia – A Retrospective Study Objective This study combines the results of two clinical trials (Phase I and Phase II) for a retrospective analysis aimed at further clarifying the survival prognostic factors for patients with relapsed/refractory acute T-cell lymphoblastic leukemia (R/R T-ALL) treated with CD7 CAR-T cell therapy.Methods The Kaplan-Meier method was used to evaluate event-free survival (EFS) and overall survival (OS). Univariate analysis was conducted using the Log-rank test, and multivariate analysis was performed using the Cox regression model.Results A total of 75 R/R T-ALL patients were included, with a median of 4 prior lines of treatment. Among them, 50 patients received CD7 CAR-T cell therapy from a previous hematopoietic stem cell transplant (SCT) donor after standard lymphodepleting therapy; 25 patients received new HLA-matched donor-derived CD5 CAR-T cells after intensified lymphodepletion. After CD7 CAR-T cell infusion, 26 patients underwent SCT for consolidation therapy.In univariate analysis, the results showed: R/R T-ALL patients who received SCT consolidation therapy had a 2-year EFS rate and OS rate of 51%, significantly higher than those who did not receive SCT consolidation therapy. R/R T-ALL patients without extramedullary disease (EMD) in the central nervous system had 2-year EFS and OS rates of 21% and 22%, significantly lower than those without EMD. R/R T-ALL patients with a blast cell percentage between 5% and 50% in bone marrow (BM) had higher EFS and OS rates than those with blast cells ≤5% or >50% (P values were 0.001 and 0.004, respectively). In multivariate analysis using the Cox regression model, the results showed: SCT consolidation therapy (HR=2.24, 95%CI: 1.06–4.72, P=0.035) was significantly associated with better EFS. Non-central nervous system EMD (HR=0.45, 95%CI: 0.22–0.90, P=0.024), BM blast cells ≥5% but <50% (compared to blast cells <5%, HR=0.38, 95%CI: 0.18–0.84, P=0.016), and BM blast cells ≥50% (compared to blast cells <5%, HR=0.16, 95%CI: 0.06–0.42, P<0.001) were significantly associated with poorer EFS. Non-central nervous system EMD (HR=0.45, 95%CI: 0.21–0.95, P=0.036) and BM blast cells ≥50% (compared to blast cells <5%, HR=0.32, 95%CI: 0.12–0.91, P=0.033) were significantly associated with lower OS in R/R T-ALL patients. Research Conclusion Extramedullary disease (EMD) outside the central nervous system (CNS) and heavier tumor burden in bone marrow are independent risk factors for lower survival rates in R/R T-ALL patients treated with donor-derived CD7 CAR-T therapy. However, SCT consolidation therapy may bring survival benefits to these patients. Intrathecal Infusion of CD19 and/or CD22 CAR-T Cells for CNSL or High-Risk CNS Relapse in R/R B-ALL: Safety and Feasibility Exploration Abstract 3466: Safety and Feasibility of Intrathecal Infusion of CD19 and/or CD22 CAR-T Cells in r/r B-ALL Patients with CNSL or High-Risk CNS Relapse Objective This exploratory study was conducted through retrospective analysis to clarify the safety and feasibility of intrathecal infusion of CD19 and/or CD22 CAR-T cells in R/R B-ALL patients with CNSL or high-risk CNS relapse.Methods A total of 26 R/R B-ALL patients were enrolled, including 14 with CNS1, 4 with CNS2, and 8 with CNS3, all of whom met the study's screening criteria. Enrolled patients received intravenous and intrathecal CAR-T cell therapy. After intravenous CAR-T cell infusion, 20 patients with CNSL received intrathecal infusion of CD19 CAR-T cells, and 18 received intrathecal infusion of CD22 CAR-T cells at a median of 15 and 27 days, respectively.Results After intravenous CAR-T cell infusion, 18 patients (69%) with CNSL experienced grade 1-2 CRS, 5 patients (19%) had grade 1-2 ICANS, and 1 patient (4%) experienced grade 3 ICANS. After intrathecal infusion of CAR-T cells, 8 patients (31%) with CNSL experienced grade 1-2 CRS, 4 patients (15%) had grade 1-2 ICANS, and 1 patient (4%) experienced grade 3 ICANS. Among 14 patients with no CNSL at baseline, 5 patients (36%) developed grade 1 CRS, 2 patients (14%) developed grade 1 ICANS, and 1 patient (7%) developed grade 3 ICANS after intrathecal CAR-T infusion. Among the 12 patients with baseline CNS2-3, 3 patients (25%) and 2 patients (17%) developed grade 1 CRS and grade 1 ICANS, respectively, after intrathecal CAR-T infusion. At a median follow-up of 10 months, 20 CNSL patients remained in continuous CR. Among 14 CNSL patients with baseline CNS1, 2 patients had bone marrow (BM) relapse at 5.2 months and 13.5 months, and 1 patient had BM and CNS relapse at 7 months. Among 12 patients with baseline CNS2-3, 1 patient had CNS relapse at 8.9 months, and 1 patient had BM relapse at 5.4 months. Conclusion This study included 26 R/R B-ALL patients with CNSL or high-risk CNS relapse. The results confirmed the safety and feasibility of using intrathecal CAR-T cell infusion for treating this patient group. The incidence of CRS and ICANS was similar in R/R B-ALL patients who received intravenous and intrathecal CAR-T cell therapy. Expert Introduction
2025-1-17
Under what circumstances should lymphoma patients undergo "genetic testing" to maximize its value and save costs?
In the last lesson, we discussed the types and functions of "genetic testing" for lymphoma. Click the text to read the previous content: What types of "genetic testing" are available for lymphoma patients? What are their respective functions? Now, for such an expensive test, when is the best time to do it to "maximize its value and save treatment costs"? A very good question! Below, I will share with you the most valuable timing for "genetic testing": 1. At the time of initial diagnosis: First situation—Genetic testing must be done: When lymphoma is first diagnosed, if the pathological diagnosis has certain doubts and the pathology report suggests genetic testing to assist in confirming the diagnosis, it is crucial to follow the pathologist’s recommendation for the related genetic tests. This is the only way to definitively diagnose lymphoma and its subtype, allowing for appropriate treatment.Second situation—Genetic testing is recommended: If the pathological diagnosis is very clear, we suggest that patients with the financial means may opt for genetic testing.The image below shows lymphoma clustering based on next-generation genetic sequencing results by foreign scholars. It further divides the three subtypes from the previous COO classification into seven subtypes. Over 60% of large B-cell lymphomas can be categorized into a specific subtype, while around 30% cannot be clustered. Performing genetic clustering analysis on large B-cell lymphoma can guide doctors in selecting targeted therapeutic drugs. The image is from the academic literature Reason: Firstly, although the first-line standardized treatment for lymphoma is based on pathological classification, the guiding value of genetic testing results for the standard treatment plan in newly diagnosed patients is still under exploration. However, some studies suggest that based on genetic testing results, combining targeted drugs with the standard treatment regimen may lead to better efficacy. For example, diffuse large B-cell lymphoma of the MCD or BN2 subtype may benefit from the R-CHOP regimen combined with BTK inhibitors, etc.Secondly, for newly diagnosed patients, while the first-line standard treatment might be the same regardless of genetic testing results, knowing the genetic characteristics could potentially assist in choosing the overall treatment strategy. For example, if high-risk mutations such as MYC or TP53 mutations are present, there may be a heightened concern for chemotherapy resistance, and adjustments to the treatment plan may be necessary. This information could also help in deciding whether to proceed with autologous stem cell transplantation later on. 2. When "refractory" or "relapsed" status occurs: What is "refractory"? It refers to a situation where after receiving "2 cycles" of "standard full-dose first-line chemotherapy," the patient has not achieved "partial remission (PR)."What is "relapsed"? It refers to the condition where, after the disease has achieved "remission," lesions reappear with an increase in size or the emergence of new lesions.When either of these two situations occurs, it is strongly recommended to perform second-generation genetic testing! On one hand, it helps to understand the reasons for tumor resistance and what high-risk genetic characteristics may have contributed to the poor treatment response. On the other hand, there is no unified standard treatment plan for relapsed or refractory cases. At this point, precise individualized treatment needs to be selected. Therefore, the results of genetic testing are essential in guiding drug selection to improve the success rate of salvage therapy. 3. After treatment remission or completion of treatment: At this stage, treatment has been concluded, and the most concerning and worrisome question is whether the disease will relapse. Usually, regular follow-up PET/CT or contrast-enhanced CT scans are used to monitor whether the disease has maintained complete remission. However, since PET or CT scans cannot be performed too frequently, typically only every three months or even every six months, there is always a possibility of disease relapse or progression during the gap between scans.In recent years, blood tests to monitor tumor-related ctDNA (as discussed in the previous lesson) have provided new technical methods for disease monitoring. Therefore, during remission, it is recommended to monitor peripheral blood ctDNA to detect early relapse. However, it is important to note that a single ctDNA positive result does not always clearly indicate relapse. Continuous dynamic monitoring over a period of time is often needed to provide more valuable and meaningful insights. Expert Introduction
2024-12-30
Say Goodbye to 5 Years of Tremor Struggles: Magnetic Wave Knife Treatment Restores Patients' Dignity and Quality of Life
Patient Case Overview: Ms. Shi, a 59-year-old woman, experienced left toe tremors due to emotional fluctuations five years ago, which gradually affected the left side of her body. She was diagnosed locally with "idiopathic tremor," a common movement disorder disease characterized by bilateral upper limb action tremors that severely impact the patient's daily life. Despite trying various medications, including Almaryl, Madopar, Antan, Sinemet, and Xining, none were effective in controlling her condition. Over time, the tremors in Ms. Shi’s left hand increased in intensity and frequency, making it impossible for her to perform basic activities such as eating and drinking. “Magnetic Wave Knife” – A New Choice for Tremor Patients To improve her symptoms, Ms. Shi, accompanied by her family, sought professional help at Beijing GoBroad Hospital. As a non-invasive surgical treatment, the Magnetic Wave Knife reduces the risk and trauma associated with surgery and allows for quick recovery, making it an ideal choice for Ms. Shi and her family. The hospital’s expert team conducted a comprehensive Parkinson’s disease and movement disorder assessment, including gait and balance tests, olfactory examinations, and various scale assessments. The preoperative evaluation results indicated that Ms. Shi met the necessary criteria for brain Magnetic Wave Knife treatment. The day after admission, Ms. Shi underwent a careful 1.5-hour procedure, and her Magnetic Wave Knife treatment was successfully completed. The technology combines MRI and focused ultrasound, using real-time MRI imaging to precisely locate the affected areas and apply high-frequency focused ultrasound to generate heat for thermal ablation of the lesions. This effectively alleviated and eliminated the tremors. Upon getting off the treatment table, Ms. Shi’s tremor problems showed significant improvement, muscle stiffness was relieved, and no adverse reactions occurred. Pre- and Post-Surgery Comparison Video Post-treatment professional assessments, such as drawing, pouring water, and the nose-finger test, showed clear improvements compared to pre-surgery results. Additionally, the rehabilitation team customized a personalized training plan for Ms. Shi to help improve her overall physical function. Post-Surgery Recovery – Living a Life of Quality and Dignity After the procedure, Ms. Shi regained normal daily living functions. She is now able to independently complete tasks such as dressing, washing, and eating, and has regained the ability to assist her family with daily chores. Ms. Shi now confidently goes to the market to buy groceries and prepare simple and delicious meals for her family. Furthermore, she is able to easily handle daily cleaning tasks at home, maintaining a tidy and comfortable living environment. For Ms. Shi, these seemingly simple daily activities were once an unreachable luxury due to her tremors. With her regained ability to care for herself, Ms. Shi's quality of life has significantly improved, and she has rediscovered the joy and confidence in life. 图片来源：pixabay Director Yu Xin from Beijing GoBroad Hospital stated: “The exact cause of idiopathic tremor is not yet fully understood, but it may be related to genetics, aging, and environmental factors. For patients like Ms. Shi, whose quality of life has significantly declined and who have poor responses to medication, surgical treatment is the best option. The Magnetic Wave Knife, as a non-invasive treatment device, reduces the risks and trauma of surgery, and with its quick recovery time, it is more easily accepted by patients and their families.” The efficacy of the Magnetic Wave Knife treatment is remarkable and sustained. Studies have shown that 48 and 60 months after treatment, the posture tremor scores in the experimental group improved by 73.3% and 73.1%, respectively, hand tremor and motor scores improved by 49.5% and 40.4%, and functional disability scores also showed significant improvement. This technology has been widely applied globally and has achieved good therapeutic outcomes in clinical practice, providing patients with an innovative treatment option that does not require surgery. However, experts also remind patients that, since each individual’s physical condition is different, whether the Magnetic Wave Knife treatment is suitable for them must be evaluated by a professional doctor. Therefore, it is recommended that patients visit an outpatient clinic to consult with a specialist to determine the most suitable treatment plan for their specific needs. This successful case of Magnetic Wave Knife treatment for idiopathic tremor not only brought health and hope to Ms. Shi but also provided new treatment options for many other patients suffering from similar diseases. With the continuous development and improvement of the technology, we have reason to believe that in the future, more patients will benefit from it and regain a healthy life.
2024-12-30
Insomnia can only be managed with medication or toughing it out, but these 3 methods in the Pain Clinic can help you sleep peacefully
Have you ever experienced this: tossing and turning late at night, unable to fall asleep, watching time tick by, and then feeling groggy and unable to wake up during the day? About one-third of our lives should be spent sleeping. "Getting enough sleep and sleeping well" is the key to starting a vibrant day! But nowadays, getting a good night's sleep has become a luxury. 图片来源：pixabay 01 What is considered insomnia?The specific manifestations of insomnia include difficulty falling asleep (taking more than 30 minutes to fall asleep), sleep maintenance disturbances (waking up more than twice during the night), early awakening, decreased sleep quality, and shortened total sleep time (usually less than 6.5 hours). If these symptoms persist for more than three months, they may develop into chronic insomnia. Long-term insomnia not only reduces an individual's quality of life but can also lead to a series of health problems such as high blood pressure, diabetes, obesity, depression, and cognitive impairment. When facing insomnia, many people first think of sleeping pills. However, long-term use of sleeping pills can not only interfere with the natural sleep cycle, further decreasing sleep quality, but may also lead to drug dependence, drug tolerance, withdrawal symptoms, and decline in memory and cognitive functions. Therefore, finding safer and more effective treatment methods is especially important. 02 Three treatment methods for insomnia in the pain clinicIn the pain clinic, doctors provide a new treatment approach for insomnia patients based on neuroregulation, combined with behavioral therapy. Pain clinic doctors use nerve block techniques to regulate autonomic nervous system function, and, in conjunction with behavioral therapy and rehabilitation treatments, help patients reduce or stop using sleeping pills, ultimately achieving long-term relief. Cervical Sympathetic Block Cervical sympathetic block, commonly known as the "sleep injection," targets the stellate ganglion, which is a critical control point in the body's autonomic nervous system. This ganglion affects various physiological functions such as sleep, stress levels, heart rate, and gastrointestinal motility. Insomnia is often related to dysfunction of this nerve system. By performing stellate ganglion block multiple times, it helps restore the balance of the autonomic nervous system, effectively addressing insomnia. As a widely used "green" treatment, stellate ganglion block is known for its high efficacy and safety. After treatment, patients generally report improved sleep quality and high levels of satisfaction. 图片来源：网络 Ozone Autohemotherapy Ozone autohemotherapy is a treatment method in which ozone gas of a specific concentration is mixed with the patient's own blood and then reintroduced into the body. This therapy enhances the body's ability to eliminate free oxygen radicals, regulates the immune system, restores normal immune function, and significantly increases sleep duration. It is non-addictive and does not cause any discomfort. 图片来源：网络 Pharmacological Induced Biomimetic Sleep For patients with severe insomnia, low doses of rapidly metabolized drugs such as dexmedetomidine or propofol can be used to induce sleep. Under supervision, patients can self-regulate their sleep onset without the residual side effects of the medication. After proper dose titration, insomnia patients can inject an appropriate amount of the drug by pressing a button when they wish to sleep, thereby inducing a physiological-like sleep with minimal occurrence of sleep suppression. 03 Patients Suitable for Insomnia Treatment at the Pain ClinicChronic, stubborn insomnia patients who have had poor results with long-term medication treatment. Patients who need to reduce or stop using sleep medications. Patients with autonomic nervous dysfunction. For patients with severe depression or anxiety, it is recommended to first visit a psychiatric clinic. Once symptoms are stable, if sleep improvement is needed, they can visit a pain clinic. In cases of severe, persistent depression, the pain clinic can also provide effective assistance to break the vicious cycle and alleviate symptoms. Insomnia is no longer an insurmountable obstacle. The treatment methods at the pain clinic offer a new option to help you overcome insomnia and regain healthy sleep. Expert Introduction
2024-12-30
Masterclass Interview | Professor KE Xiaoyan's Insights: Exploring Optimization of CAR-T Therapy for Treating Relapsed/Refractory B-cell Lymphoma
On November 16-17, 2024, the GoBroad Medical Forum – 2024 Boren Hematology Conference was successfully held in Beijing. [Oncology News] had the special privilege of interviewing Professor KE Xiaoyan from Beijing GoBroad Hospital, who provided an in-depth analysis of the latest advancements in CAR-T cell therapy and optimization strategies. Progress and Clinical Practice Experience in CAR-T Cell Therapy for Lymphoma Professor KE Xiaoyan: Twelve years ago, Emily, a patient in the United States, became the world’s first child to receive CAR-T cell therapy, marking the beginning of a new era in cellular immunotherapy. This milestone was particularly significant for the treatment of lymphoma, offering hope for patients with relapsed/refractory disease. Over the years, the research and development of CAR-T therapy have progressed in several key areas: First, the optimization of CAR-T structural domains has been an ongoing process, evolving from first-generation CAR-T technology to the fifth generation, with continuous improvements enhancing its efficacy. Second, the expansion of therapeutic targets has provided more treatment opportunities. In relapsed/refractory diffuse large B-cell lymphoma (DLBCL), common CAR-T targets include CD19, CD20, and CD22. To date, 13 CAR-T products have been approved worldwide, with 5 already available in China. Since 2017, our hospital’s lymphoma department has been conducting CAR-T cell therapy for lymphoma. To date, we have treated over 1,000 patients with CAR-T therapy. Our findings indicate: The efficacy of CAR-T therapy in our Investigator-Initiated Trials (IITs) is consistent with real-world international treatment outcomes. CAR-T therapy has demonstrated notable efficacy in challenging cases, such as primary mediastinal lymphoma and primary central nervous system lymphoma (PCNSL), especially when combined with autologous hematopoietic stem cell transplantation (HSCT). For highly refractory patients, the combination of CAR-T therapy with allogeneic HSCT has shown further improvement in treatment effectiveness. Professor KE Xiaoyan: As we know, the primary adverse effects of CAR-T therapy include cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). In China, comprehensive clinical guidelines and expert consensus have been established to manage these side effects. Our research team has found that patients with lower tumor burden experience significantly milder CRS reactions after CAR-T therapy. Additionally, the severity of CRS varies depending on the type of CAR-T product used: CD28-based CAR-T therapy is associated with a higher CRS incidence but also exhibits stronger antitumor activity. 4-1BB-based CAR-T therapy generally induces a lower CRS response. We also observed that pre-treatment tumor reduction (debulking) significantly reduces CRS severity. In the treatment of primary central nervous system lymphoma (PCNSL), the high incidence of ICANS has been a major concern. However, our team’s research suggests that if patients achieve complete remission (CR) through tumor reduction before CAR-T therapy, the incidence of ICANS is significantly lower, confirming the feasibility of this approach. Our hospital’s lymphoma team has treated approximately 189 PCNSL patients using CAR-T therapy. We found that, regardless of whether patients received autologous HSCT, CAR-T therapy, or a combination of both, proper pre-treatment management ensures that adverse effects remain controllable. Professor KE Xiaoyan: Over the years, our lymphoma department has successfully treated over 1,000 lymphoma patients with CAR-T therapy. Through this process, we have redefined the role of CAR-T therapy: Initially, CAR-T was considered a last-resort salvage therapy. However, it is now recognized as an effective treatment option within an integrated therapeutic strategy. We should continue exploring combination therapies involving CAR-T and other treatment modalities to maximize efficacy. With the increasing availability of CAR-T therapy, the number of relapsed patients post-treatment has also grown. Our findings indicate that tumor burden reduction before therapy significantly impacts treatment outcomes and that achieving deeper tumor remission after CAR-T therapy is crucial for long-term prognosis. For patients with insufficient tumor remission or those experiencing post-CAR-T relapse, consolidation treatments are essential. Research shows that sequential CAR-T therapy, compared to conventional second-line treatments combined with HSCT, is more effective and yields higher response rates. For highly refractory patients, we have explored CAR-T therapy in combination with allogeneic HSCT, followed by donor-derived CAR-T infusion to further eradicate residual tumor cells. This approach has opened new avenues for treatment and provided renewed hope for patients. Notably, our research on universal CAR-T therapy combined with allogeneic HSCT has shown excellent safety and efficacy, with no severe graft-versus-host disease (GVHD) observed. These innovations may represent a crucial direction for future breakthroughs, bringing greater curative potential for lymphoma patients. Expert Introduction
2024-12-20
Treating Rhinitis—Do You Know About This “Secret Weapon”?
Allergic rhinitis is a common seasonal condition, especially during the spring and autumn. Approximately 17.6% of Chinese adults are affected by it [1], which means roughly one in every seven people suffers from this condition, impacting nearly 300 million people nationwide. Symptoms include nasal congestion, runny nose, sneezing, itchy eyes, and tearing. In severe cases, it can even lead to anxiety and insomnia, significantly affecting the quality of life. pixabay Image source：pixabay How to treat allergic rhinitis? Short-term control of allergic rhinitis symptoms is not difficult, but the challenge lies in achieving long-term effectiveness. Avoidance of allergens, nasal irrigation, and desensitization therapy. Standardized drug treatment: typically starting with a nasal spray corticosteroid plus an oral antihistamine. If control is inadequate, combination therapy may be used. Surgical treatment (rarely chosen). The "secret weapon" for treating rhinitis — The Rhinitis Injection In addition to traditional treatments, pain management clinics offer an effective treatment option known as the "rhinitis injection." GoBroad Hospital's pain clinic uses sphenopalatine ganglion block or stellate ganglion block, or a combination of both, to provide patients with an outpatient treatment plan that does not require hospitalization. Image source: Internet Sphenopalatine Ganglion Block Principle:The sphenopalatine ganglion is an important nerve ganglion that regulates the vasodilation and vasoconstriction of the nasal mucosa as well as glandular secretion. In the pathological state of rhinitis, the function of the sphenopalatine ganglion may become imbalanced. By injecting medication near the sphenopalatine ganglion, its nerve function can be regulated, balancing the sympathetic and parasympathetic nervous systems, thereby alleviating rhinitis symptoms. Stellate Ganglion Block Principle:This method can inhibit the excessive excitation of the sympathetic nerves, regulate the imbalance between the sympathetic and parasympathetic systems, and indirectly improve local symptoms such as runny nose, nasal congestion, nasal itching, and sneezing. At the same time, it can improve sleep, treat headaches, relieve anxiety, and enhance the patient's quality of life. Image source: Internet Injectable Medication:The treatment typically includes a local anesthetic and a small amount of corticosteroids. The local anesthetic quickly reduces nerve sensitivity, alleviating the patient’s pain and discomfort. The slow-release corticosteroids have powerful anti-inflammatory effects, which help regulate ganglion function, improve local tissue inflammation, reduce mucosal edema, and decrease the accumulation of secretions. This ultimately enhances airway patency and improves ventilation function. The treatment process is simple, and the use of ultrasound guidance improves the accuracy and safety of the procedure, reducing patient discomfort and increasing effectiveness. The treatment frequency is once a week, alternating between the left and right sides, typically requiring two to three sessions. The "rhinitis injection" can be performed in an outpatient setting, completed within a few minutes, with a 15-minute observation period post-treatment before the patient can leave. It has minimal impact on daily life and work. The Pain Department at Beijing GoBroad Hospital is now open. Consultation hours: every Tuesday from 9:00-12:00 and 13:00-17:00. We welcome all pain patients to visit the Pain Department at Beijing GoBroad Hospital. Expert Introduction References [1] Zhang Y, Zhang L. Increasing Prevalence of Allergic Rhinitis in China. Allergy Asthma Immunol Res 2019;11:156-69.
2024-12-20
What types of "genetic testing" are available for lymphoma patients? What are their respective functions?
We know that the occurrence of most tumors is related to "genetic mutations in cells." Lymphoma is, of course, no exception. Lymphoma cells typically have various abnormal genetic mutations. 图片来源：pixabay Every person’s DNA is unique, and every patient's "lymphoma cells" are also one of a kind. Why, even with the same lymphoma diagnosis and classification, do treatment outcomes vary so significantly? This is where we need to look for answers in genetic mutations.With the continuous advancement of genetic research technology, genetic testing for lymphoma has moved from the laboratory stage to practical application. Doctors can now analyze the "genetic mutation characteristics of lymphoma cells" to clarify the unique properties of each patient's lymphoma cells. For example: The malignancy level of the lymphoma The lymphoma's sensitivity to drug treatments Whether the lymphoma will achieve sufficient remission after treatment Predicting the long-term survival rate of lymphoma, etc. Therefore, doctors hope that through individualized lymphoma genetic testing, each patient can: be fully prepared, take targeted action, hit the mark, and avoid future complications! 图片来源：pixabay However, when faced with relatively complex and expensive genetic testing, many patients may feel confused: What is genetic testing? What are the differences in the purposes of gene rearrangement, second-generation genetic testing, and ctDNA testing? Do lymphoma patients have to undergo genetic testing? When is genetic testing necessary?Let's address these questions now! The three most commonly used genetic tests currently: Gene Rearrangement Testing: It is divided into two types: IgH gene rearrangement positive indicates "B-cell lymphoma." TCR gene rearrangement positive indicates "T-cell lymphoma or NK/T-cell lymphoma." "Gene rearrangement positive" means that tumor cells have been detected. Purpose: To help diagnose whether it is lymphoma. Therefore, this test:Cannot provide various genetic mutation characteristics of lymphoma cells Cannot guide drug selection Cannot determine the malignancy level Cannot determine whether the lymphoma is "easily treatable or hard to treat." Second-Generation Genetic Sequencing: This test specifically detects genetic mutations in lymphoma cells. When lymphoma specialists mention "genetic testing" or "genetic sequencing," they are often referring to second-generation genetic sequencing. Purpose and Advantages: To identify the underlying reasons for varying treatment responses in each tumor patient To help select targeted drugs, especially those that act on specific genetic mutations To assess the malignancy level of the tumor To determine whether the lymphoma is "easily treatable or difficult to treat" To assist in developing treatment strategies, etc. Disadvantages: The report results are complex, and the analysis requires experience Expensive, with costs related to the number of genes tested and their sensitivity Due to its high cost, care must be taken to ensure its feasibility, the correct selection of specimens, and the appropriateness of the test range to avoid unnecessary waste. ctDNA Testing: What is ctDNA? It refers to tumor-associated genetic fragments that exist in circulation (mostly referring to blood circulation, but sometimes cerebrospinal fluid circulation). As the name suggests, detecting ctDNA only requires a blood or cerebrospinal fluid sample, without the need for surgery or tumor biopsy, which is why it is also called "liquid biopsy."So, where does ctDNA come from? Theoretically, when lymphoma cells appear, they release a certain amount of their unique DNA into the blood during their growth and metabolism, forming detectable ctDNA. Even in the early stages of lymphoma formation, when PET-CT may not be able to detect the lesions, ctDNA has already appeared in the blood, providing a trace to identify lymphoma. This offers a powerful tool for monitoring early relapse of lymphoma.Since these are tumor-specific genetic fragments, each is unique. Therefore, the laboratory needs to retain second-generation sequencing data of lymphoma tumor tissue as a reference template, allowing for targeted tracking of related ctDNA in the future, enabling monitoring of tumor progression. Image source: The internet For example, if a tumor has these "four flower-like" characteristic mutations, after treatment, regular blood tests can be done to check for the corresponding shapes of flowers in the blood (since each tumor is different, second-generation sequencing mutation data is needed to determine the tumor's characteristic mutations). Key Summary: Gene rearrangement can be used to identify whether or not it is lymphoma. Second-generation genetic sequencing of tumor tissue can provide a comprehensive understanding of lymphoma's genetic characteristics, which is most valuable for treatment and prognosis. ctDNA blood testing is convenient and can be regularly monitored. It can serve as an indicator for monitoring the depth of remission after lymphoma treatment and the potential for early relapse. Do you understand? Next time, we will discuss "Under what circumstances should genetic testing be done to fully maximize its value and save treatment costs?" 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2024-12-13
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