Maloney deemed this an unanswerable question, and he provided substantial data from many trials to support that opinion.
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Some physicians might still choose observation in advanced-stage asymptomatic follicular lymphoma because early studies of initial chemotherapy versus observation until treatment when required did not show a survival advantage for either option, he said. Since none of those studies randomized totally asymptomatic patients to an aggressive chemotherapy or rituximab-based regimen now commonly used, the answer is not clear, he said.
If a patient wants to be treated, I don't twist their arm and say you can't be treated.
But many patients are still only under observation initially. The study showed that the 2, patients with low-grade follicular lymphoma included were initially managed after diagnosis by: 3. Among the He said he would consider rituximab followed by rituximab maintenance in asymptomatic patients, although one could also make a strong argument to give rituximab-chemo, he said.
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Single-agent rituximab with or without maintenance or retreatment can be a choice for patients who are minimally symptomatic, elderly, or for whom chemotherapy is not indicated. And event-free survival is generally around 36 months, depending on whether maintenance is given. Maloney said the single-agent approach can work for two to three years, if it is given on either an extended schedule of four extra doses such as in the Swiss SAKK trial led Dr. John Hainsworth JCO, This is a reasonable approach, he said, but he questioned whether it is really warranted when a much higher response rate and longer duration can be achieved with rituximab plus chemotherapy.
The most common approach for aggressive presentations of the disease is rituximab with chemotherapy—CHOP, CVP, or bendamustine—followed by maintenance rituximab, he said.
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I'm sure that this will provoke a lot of discussion, but that this is my choice, based on the PRIMA study. Finally, he said, there is rituximab with chemotherapy or chemotherapy alone followed by either consolidative radioimmunotherapy or maintenance rituximab. Unfortunately, we've been waiting a while, and I haven't seen one yet that has beaten rituximab.
Maloney reminded the audience that patients with follicular lymphoma can have many different outcomes.
Professor Sally Barrington
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How Do I Treat? Your Name: optional. Your Email:. The patients were given a relatively low dose of psilocybin, 0. Nonetheless, the team reported in the Archives of General Psychiatry, all patients reported a significant improvement in mood for at least two weeks after the psilocybin treatment and up to a six-month improvement on a scale that measures depression and anxiety. Most also reported a decreased need for narcotic pain relievers. No adverse reactions were observed.
All three researchers had to jump through many federal and local regulatory hoops to obtain approval for the experiments. Now the problem is obtaining subjects, Griffiths said. All three discouraged cancer patients from using the hallucinogen on their own. Psilocybin is illegal and listed in the same class of drugs as LSD and heroin, according to the Department of Justice. About Us.