Thursday, May 31, 2007

Fred Thompson and Lymphoma - The Answer.

This keeps coming up every time a new group of people start noticing Fred Thompson. Here is some info I wrote in mid April (bumped up to today)


Fred Thompson was diagnosed in November 2004 with nodal marginal zone lymphoma, an indolent B-cell lymphoma. Nodal marginal zone lymphomas account for only 1% all Non-Hodgkins Lymphomas(NHL). It was treated with rituximab, he is in remission. Fred Thompson himself says "I have had no illness from it, or even any symptoms. My life expectancy should not be affected." Furthermore, his oncologist says "he is no longer in treatment as he is in remission. Doctors cannot currently detect the lymphoma by physical examinations or scans. Senator Thompson has never been physically ill or had any symptoms from his lymphoma or had any side effects from the therapy." Bruce D. Cheson, M.D. Professor of Medicine Head of Hematology Division of Hematology/Oncology.

For complete diagnosis, prognosis, and treatment analysis use the Read More and read below the fold.

The Rest of the Story...

Some have questions about use of rituximab in early therapy. Ruling out CHOP since this is not a diffuse large B cell lymphoma, a standard treatment for a number of NHLs is R-CVP, of which rituximab is a component (its the "R"). I note that this is more often a stage 3-4 treatment, and since they did not mention chemo and steroids (the "C" is chlorambucil, the P is prednisone), I doubt this (R-CVP) is what was used. Rituximab is approved for other uses (Rheumatoid arthritis for instance), and this may have been an "off label" therapy decided upon by the oncologist and the patient's risk tolerance and desires. (And for the non-medical folks, rituximab is a genetic vectored therapy that targets only the lymphoma cells, not a chemo that hits the whole body).

From my consultations and surveying, this is a bit aggressive in terms of standard treatments; Were I in Fred Thompson's position I would consider the risks to be worth it, givner his family situation. Taking bit of a risk with a harder treatment line is worth it in terms of better life expectancy. And it beats chlorambucil's potential (chemo) side effects - rituximab is simpler for the patient (usually via IV infusion 1 time a week for 4 weeks).

Furthermore, any person making a claim of "Stage 2" or worse is squarely at odds with reality. For those of you unfamiliar, here are the general definitions of the first two NHL stages:

Stage 1 The lymphoma is only in one group of lymph nodes, in one particular area of the body.

Stage 2 More than one group of lymph nodes is affected, but all the affected nodes are contained within either the upper half or the lower half of the body.

Given the descriptions of a single lump under the jaw and no other areas involved (the armpits and/or neck would have been stated had it been stage 2), Sen Thompson's lymphoma was very likely stage 1.

Secondarily, the medical literature available very much disputes any presumption that people die from the disease more often than other causes. I believe anyone that says otherwise is mis-characterizing it. This is based on talking to an oncologist that I know, and from others experienced in the field. There may be other info more current that his oncologist in Georgetown has than what has been publicly cited (not to mention typical press laziness has them citing outcomes for the wrong disease). Here are some sources for to consult - they proved valuable for me, and might educate you.

Oxford Textbook of Oncology (2nd edition). Eds Souhami et al. Oxford University Press, 2002.

Wintrobe’s Clinical Haematology (11th edition). Eds Lee et al. Williams and Wilkins, 2004.

Malignant Lymphoma. Eds Hancock et al. Arnold, 2000.

Improving Outcomes in Haemato-oncology. National Institute of Clinical Excellence, November 2003.

British Committee for Standards in Haematology guidelines on nodal non-Hodgkin lymphoma, draft 2. August 2002

On top of all that, a direct quote from Thompson's doctor basically demolishes anyone taking the position that Sen Thompson is physically at risk for serving out his term:

"Some lymphomas are very aggressive, but people with slow-growing types, like Senator Thompson's, often dying from natural causes associated with old age, rather than from the disease. In 2004, Senator Thompson was diagnosed with a form of lymphoma. Today, he is in remission from this, slow-growing disease. Senator Thompson chose to receive such therapy (Rituxan), but he is no longer in treatment as he is in remission. Doctors cannot currently detect the lymphoma by physical examinations or scans. Senator Thompson has never been physically ill or had any symptoms from his lymphoma or had any side effects from the therapy." Bruce D. Cheson, M.D. Professor of Medicine Head of Hematology Division of Hematology/Oncology.

The one thing that people do get right is that there would probably be a recurrence eventually, followed by likely re-treatment with rituximab. That much was stated by Sen Thompson's oncologist in an interview later.

But most damning statement for critics and would be sowers of Fear Uncertainty and Dobut, are the words from Fred Thompson himself: "I have had no illness from it, or even any symptoms. My life expectancy should not be affected."

So, to the FUDsters: Are you accusing Fred Thompson of lying to the public about his fitness for the Presidency? Or, more likely, is it that you are overstating and misrepresenting the case? In effect, I believe the critics are trying to discredit by use of half truths - and to me, thats disingenuous and deceitful, unless its out of pure ignorance. With this info, I hope to I solve the problem of ignorance with a bit of research and people I know in the medical field. So could any journalist were he not being lazy

So, yes Fred Thompson has a form of cancer, but not it is not as debilitating and disqualifying as many attempt to make it out to be, and their diagnosis and prognosis the speculate on are flat out wrong and appear to be simply a scare tactic.

I suggest they stick to the facts - lest they be called on them, and shown to be lying or ignorant (like I showed here). Leave diagnosis and prognosis of lymphomas up to real doctors involved in this - professional oncologists.

The bottom line is: Were Thompson truly at such a risk as disengenuously inferred, he would not run, its not in his character.

To say otherwise reveals even more about questioner than it does his target, the candidate.

Courtesy of Ordinary Coloradan at Colorado For Thompson Blog

Consider one other thing: you now have no excuses you can attribute to ignorance.

And there you have it - feel free to use the direct link to the article.

3 comments:

Colorado said...

This is good data. It totally blows Hugh Hewitt out of the water.

Colorado said...

And start blogging again dude!

rwseed said...

I understand he has stage III disease and was radiated first in the neck and a year later received monclonal fusion protein treatment. What is the prognosis for Stage III, 64 year old? That is what percentage convert? 5% in 10 years?


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