Large granular lymphocyte (LGL) leukemia is a rare form of blood cancer, with less than 1,000 new cases diagnosed in the U.S. each year. Because it is so rare, the disease is often misdiagnosed or overlooked. UVA Cancer Center director Thomas P. Loughran Jr., MD, discovered the disease over 30 years ago. He has since dedicated his research and clinical focus to understanding LGL leukemia.

https://uvahealth.com/services..../lgl-leukemia-progra

My name is Tom Loughran. I'm a physician-scientist, and I'm a professor of medicine here at UVA. We have a very organized team to take care of patients with a rare disease called
LGL leukemia. It stands for large granular lymphocyte leukemia.

I discovered this illness when I was a fellow at the Fred Hutchinson Cancer Research Center.

LGL leukemia is rare. We estimate maybe a thousand new patients every year are getting diagnosed with this illness in the United States. Because of that, even physicians in my field of hematology/oncology are not that familiar with how to make a diagnosis.

Patients do come from all around the world to see me. And so we have really focused a lot, both in the clinic and the laboratory, on this one illness. We have, for example, established the internationally recognized criteria on how to make a diagnosis of LGL leukemia.

We've advanced the field in the laboratory, trying to figure out the biology of the illness, its pathogenesis, and the problems patients might have. This has led to the major clinical treatment recommendations that have come from our research.

It's always a great idea for a patient who thinks they may have that illness to come here and visit with our team. Basically, it's a very state-of-the-art comprehensive evaluation of their illness. It's very reassuring to the patient, and personal attention is given to the patient throughout their visit.

For 20 years, Doug Olson lived with chronic lymphocytic leukemia (CLL). CLL is a cancer that starts in the bone marrow. It causes white blood cells to grow out of control and prevents the immune system from protecting the body against illness or infection.

The cancer was relentless. After four rounds of chemotherapy, 40 percent of his bone marrow was still overrun with cancer. His oncologist, David Porter, MD, recommended they try a bone marrow transplant, an idea that terrified Doug. There had to be another option.

Then Dr. Porter suggested something revoluntionary: targeted T-cell immunotherapy. Immunotherapy would use Doug's own immune system to fight the cancer. He agreed to try it, feeling "suddenly there was new hope and a way to fight."

Three weeks after receiving the immunotherapy, Doug's medical team couldn't find one remaining leukemia cell. Not one.

Learn more about immunotherapy treatment: http://bit.ly/298lXKh
Learn more about Dr. Porter: http://bit.ly/2aNKkhf
Read Doug's story: http://bit.ly/2auyz0I
Request an appointment at Penn: http://bit.ly/2awHr1T

Summary: CAR T-cell therapy is a new treatment option for patients with acute lymphoblastic leukemia, some lymphomas, and multiple myeloma that have not responded to prior therapies. This presentation describes how CAR T cell therapy works, its risks and side effects, and how these may be effectively managed.

This presentation was made possible, in part, by Kite, a Gilead Company.

Presenter: Michael Tees MD, MPH, Colorado Blood Cancer Institute, part of the Sarah Cannon Cancer Institute at Presbyterian/St. Luke’s Medical Center

Meet the speaker: https://faculty.mdanderson.org..../profiles/ajay_shesh

To read the transcript, go to: https://www.bmtinfonet.org/vid....eo/2022-car-T-cell-t

Highlights:

CAR T cell therapy involves removing some of a patient’s T-cells and engineering them to recognize particular cancer cells. These enhanced T-cells are then returned to the patient’s body where they can attack cancer cells.
CAR T therapy can cause cytokine release syndrome leading to fever, lower blood pressure, and shortness of breath. The likelihood of this side effect is high, but its severity varies a lot. There are several treatments for this problem.
CAR T-cell therapy can also cause neurotoxicity or ICANS. The likelihood, severity and symptoms of neurological problems vary with the underlying disease. Neurotoxicity is almost always reversible.

May 3, 2022 Part of the Virtual Celebrating a Second Chance at Life Symposium 2022
Presentation is 39 minutes long with 20 minutes of Q & A.

Key Points:

(07:50): CAR-T cell therapy is currently approved for B-cell acute lymphoblastic leukemia, some lymphomas and multiple myeloma if other treatments have failed.

(09:46): Acute myeloid leukemia, myelofibrosis and some solid tumors are not yet good candidates for CAR T therapy.

(13:23): The correct T-cells must be selected for conversion to CAR T-cells in order to be effective.

(13:42): Viruses are used to insert genetic material into T-cells and convert them to CAR T-cells.

(15:38): Patients with aggressive disease may require bridging therapy to control their disease while CAR T-cells are being created.

(17:41): The major side effects between Day 0 and 28 are infection, cytokine release syndrome and neurotoxicity.

(27:46): After CAR T-cell therapy, “chemo brain” or “brain fog” can affect concentration and short term memory.

(29:45): Low blood counts and ongoing risk of infection are possible late effects of CAR T-cell therapy.

(32:33): Patients do not respond well to the COVID vaccine after CAR T-cell therapy, so precautions against COVID, like wearing a mask for a year, are important.

(33:39): Anti-viral therapy is recommended after CAR T-cell therapy to reduce the risk of shingles.


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Chronic Lymphocytic Leukemia (Free NCLEX Review)

We're discussing Chronic Lymphocytic Leukemia in this free NCLEX Review!

B lymphocytes or B-cells are humoral immune effectors that provide defense against infections through a variety of tasks, including antibody production. When a clonal malignancy develops in B-lymphocytes production this leads to Chronic Lymphocytic Leukemia. The disease is usually indolent, with slowly progressive accumulation of long-lived small lymphocytes. These cells are immune incompetent and respond poorly to antigenic stimulation.

00:00 Introduction
03:11 What is Chronic Lymphocytic Leukemia
08:11 Chronic Lymphocytic Leukemia Classification
11:43 Clinical Manifestations
18:15 Management
22:11 Nursing Considerations
24:04 NCLEX Practice Questions

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