Diagnósticos avanzados, enfoques inmunológicos y ensayos clínicos innovadores, y con la ayuda de una extensa base de datos de historias de pacientes que se inició en 1985, se siguen haciendo avances en el campo del linfoma. Estos avances proporcionan una mejor comprensión de la biología de los linfomas, lo que lleva a diagnósticos más precisos y mejores opciones de tratamiento para los pacientes.
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I started the Mayo Clinic Lymphoma Database. In 1985 we have over 31,000 patients in that we have our program and our, our leo and and grant, we're able to do just remarkable studies on our own. And then in collaboration nationally and internationally, we really believe that clinical trials are the way to affect change and the way to affect outcomes in patients. We have a phenomenal group of homa pathologists constantly affecting change in in in their protocols and adding new new tests. One example of that is some of the studies that we've done looking at fish testing and lymphoma and determining basically that, you know, we take a certain approach to fish testing and diffuse large B cell lymphoma. So for our diffuse large B cell lymphomas, we know that a double hit lymphoma which has a my rearrangement and ABC L two rearrangement is a poor prognosis for the patient. So it's very important to identify those. And so we've developed essentially a triage system where first we fish for M and then we fish for BC L two. If the mic is rearranged, we also did a study by looking at retrospective data that just doing what's called a Mick break apart probe by fish alone was missing a certain percentage of Mick rearrangements. We determined that adding a dual fusion migh probe along with the MC break apart probe up front would catch about 4% more of those arrangements that we were missing by just using the m break apart probe. So these were patients who potentially were told you have diffuse large b cell lymphoma. When they should have been told you have a double hit lymphoma, um which is a higher grade lymphoma which behaves more aggressively and responds better to more aggressive therapy. Because of the now more widespread availability of different genetic testing of the tumor within pathology. We're much better able to understand the biology of these lymphomas and better able to translate that into our diagnoses. So, classifications of these diseases are always changing because of that, of those discoveries that are being made in the genetic realm. We're now taking very aggressive disease and taking an immunologic approach. The therapies that are now starting to really impact the relapse refractory patients after transplant in both in different settings are the car T cell therapies for the patients who are treated on the cart studies overall, you know, when you look at that, we're talking about complete remission rate, you know, in the 30 to 40% range and even higher for, for more rare type of lymphoma. Now that we've had 34 year follow up for the patients who's responded close to 30 to 40% of them have remained in remission for a very long period of time. So now you're, you're talking about the median overall survival across studies are closer to, you know, 23 year range or longer. So that's AAA dramatic difference. And that's why we think this therapy is so transformative because there is a potential for cure for the patients who respond to this treatment. One of the question is, you know, who are the people to get cart therapy? And that I think is an area of um still ongoing challenge and unmet needs in the sense that it is very individualized uh personal medicine, right? We're taking cells from the patient, we're manufacturing these car t from the patient's own T cells. So essentially each car T product is its own batch, its own lot of living drug. We've started our own um manufacturing so we can make these carts on site and get, get them to patients sooner. There are larger multi center studies in earlier settings. So now that we know it works after two lines of therapies and there have been a randomized study uh comparing patients to get car T versus autologous stem cell transplant in the second line setting. So now we're trying to move it up one notch. The hope is that we're gonna develop better cars, more specific cars, uh and less toxic cars but that is really changing the landscape over the last literally 24 months. I think this is just the beginning, you know, this is not the end. All, what we're seeing is really the very first generation of cart and what it can do for, for patients.
