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  • Destiny Stone
    Destiny Stone

    Promising Aggressive Treatments for T-Cell Lymphoma

    Celiac.com 03/16/2010 - Enteropathy associated T-cell lymphoma (EATL)  is a rare type of peripheral T-cell lymphoma that is commonly associated with celiac disease.  A group at The Newcastle  Lymphoma Group in the  United Kingdom, evaluated data from newly diagnosed patients in Northern England and Scotland between 1994 and 1998, in search of increased overall survival (OS) rates and progression free survival (PFS) rates for EATL patients.

    Celiac disease (celiac disease) is the most common food intolerance disorder affecting Western civilization today. While most celiacs show an improvement in their health after  initiating a gluten free diet,  2-5%  of patients do not improve, and are thus considered to have refractory celiac disease (RCD).

    RCD is further classified into two categories, Type 1 with intraepithelial lymphocytes of normal phenotype, or as type 2 with clonal expansion of intraepithelial lymphocytes with an aberrant phenotype. Type 2 patients are expected to have a five year overall survival rate (OS) of 50%-58%, and most Type 2 RCD  patients die from EATL.

    EATL generally affects older patients in their 60's or 70's, with a history of celiac disease or RCD, and is most frequently presented in the form of malabsorption along with abdominal pain. However, EATL is not exclusive to patients with celiac disease or RCD and has also been found in patients without a history of either. Standard treatments until now have included surgical resection, with or without anthracycline-based chemotherapy, or high-dose chemotherapy with autologous stem cell transplant (ASCT). Results of these treatments have been dismal, with the patient typically dying from disease related complications.

    Using a population-based setting, 26 EATL patients that qualified for intensive treatment were given the new aggressive treatment of, ifosfamide, vincristine, etoposide / methotrexate (IVE/MTX) &  ASCT, and their results were compared to that of the historical group. Statistically there was no difference between the groups; all groups had similar age, sex and features at initial evaluation. For all patients treated with the historical cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) therapy, the average PFS rate was approximately three months, and the average OS rate was about seven months. However,  the IVE/MTX - ASCT group showed a significantly higher five year PFS and OS compared to patients treated with the  historical CHOP therapy. Additionally, patients treated with IVE/MTX - ASCT showed improvement in their remission rates, and had profound reduction of death rates compared to the group treated with the historical CHOP chemotherapy. Of the patients that were solely treated with surgery, none survived.

    While EATL has a somber outcome for most patients treated with conventional CHOP treatments, data collected from these tests reveal that the regime IVE/MTX – ASCT shows exceptional promise as a new treatment. It is recommended that EATL patients enter themselves into national studies like this one, to expand research data and to help explore potentially effective EATL treatment options.

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  • About Me

    I diagnosed myself for gluten intolerance after a lifetime of bizarre, seemingly unrelated afflictions. If my doctors had their way, I would have already undergone neck surgery, still be on 3 different inhalers for asthma, be vomiting daily and having chronic panic attacks. However, since eliminating gluten from my diet in May 2009, I no longer suffer from any of those things. Even with the proof in the pudding (or gluten) my doctors now want me to ingest gluten to test for celiac-no can do.

  • Related Articles

    Dr. Ron Hoggan, Ed.D.
    The following piece was written by Ronald Hoggan who is a teacher at Queen Elizabeth High School in Calgary, Alberta, Canada.
    There is much evidence linking untreated celiac disease with malignancy. I have recently been notified of publication of a report I have written on that connection, which is promised for the September, 1997 issue of Medical Hypotheses (1). In that report, I combine a review of the literature with an outline of a possible biochemical pathway whereby psychoactive peptides derived from the pepsin digests of wheat, rye and barley may down-regulate the activation of natural killer cells, the bodys first line of defense against malignancy. This is not a postulation that glutinous grains are carcinogenic. Humankind has been exposed to carcinogens throughout its ~ two million year evolution. But it is only in recent centuries that malignancy has increased exponentially, and has struck so many children and adolescents. This is clearly a counter-evolutionary trend when youngsters are afflicted, because the incidence should be decreasing over time, as these youngsters genes are being pruned from the gene pool. There is some evidence that has come to light since my aforementioned report, which will be of interest to celiacs and members of their families.
    M. Stanislas Tanchou, a truly visionary physician, and campaigned with Napoleon Bonaparte, presented a paper to the Paris Science Society in 1843, which was a complex statistical examination of malignancy, offering evidence of increased malignancy with increased civilization (2). One of the prime indicators of a civilizing trend was a diet that included cereal grains. The greater the consumption of these foods, the greater the incidence of malignancy (3).
    Dr. Chris Reading, an orthomolecular psychiatrist, in Australia, has documented the treatment of five cancer patients for depression (4). His testing for food allergies, and subsequent treatment of depression with dietary exclusion of cereal grains resulted in total remission of the cancers (which were also given conventional treatments) in all five patients he reports treating. One of these patients did die, but that was from the cancer treatment.
    There are also two reports in the Journal of Clinical Gastroenterology (5) Lancet (6) that I cite in my Medical Hypotheses article. These reveal a total remission of malignancy in each patient. One report then recants the original diagnosis, and identifies the correct diagnosis as lymphadenopathy. In the other report, which spurs a heated debate, the original diagnosis is supported by a resected section of malignant bowel, and there can be no doubt as to the correct diagnosis.
    Further, in a 1977 report, in Nutrition and Cancer (8), from Stanford University, all the children suffering from radiation and chemotherapy damage to the small bowel recovered fully from their chronic enteritis, and suffered no relapse of either the bowel obstruction or the disease. The treatment they were given was a gluten-free, dairy-free, low fat, low residue diet.
    In an obscure Czech journal, a report has recently indicated that one or more of the gliadins, a sub-set of proteins in gluten, may also interfere with natural killer cell activation in peripheral blood (9). They tested the levels of natural killer cell activation in normal, and in treated celiacs, and found no significant difference. BUT, after 30 minutes exposure of the celiacs blood to gliadin, there was a reduced activation of natural killer cells.
    For the last hundred years, billions of dollars have been spent identifying carcinogens. Most of what we encounter in our environment appears to have some measure of carcinogenic potential. Unfortunately, we have failed to reconcile that Humanity has been exposed to most of these carcinogens throughout its evolution. Conventional wisdom has pointed to the increasing levels of chemical pollution and environmental damage. And I do not doubt that these factors are contributing to the current epidemic of malignancy. What I do doubt is that segment of the population, variously reported at 20% to 30%, which has the HLA factors which predispose to celiac disease and many other autoimmune diseases, can mount an adequate immune response, with natural killer cells, against malignancy.
    References: Hoggan R, Considering Wheat, Rye, and Barley Proteins as Aids to Carcinogens in press Medical Hypotheses, 1997. Tanchou S, Statistics of Cancer London Lancet 1843; Aug 5, 593. Audette R, personal communication. Reading C, Meillon R, Your Family Tree Connection, Keats; New Canaan, Conn.: 1988. Wink A, et. al. Disappearance of Mesenteric Lymphadenopathy with Gluten-Free Deit in Celiac Sprue, J. Clin. Gastroenterol, 1993; 16(4): 317-319. Wright DH, et. al. Celiac disease and Lymphoma, Lancet 1991; 337:1373. Wright DH, et. al. letter Lancet 1991; 338: 318-319. Donaldson SS, Effect of Nutrition as Related to Radiation and Chemotherapy, Nutrition and Cancer, Winick ed. 1977; Wiley & Sons, NewYork, 137153. Castany M, Nguyen H, Pospisil M, Fric P, Tlaskalova-Hogenova H, Natural Killer Cell Activity in Celiac Disease: Effect of in Vitro Treatment on Effector Lymphocytes and/or Target Lymphoblastoid, Myeloid and Epithelial Cell Lines with Gliadin, Folia Microbial, 1995 (Praha) 40; 6: 615-620.

    Scott Adams
    QJM, May 1, 2003; 96(5): 345 - 353
    Celiac.com 05/29/2003 – A survey was recently conducted by Professor P.D. Howdle, St. Jamess University Hospital (UK), et al, to estimate the frequency in the UK of small bowel malignancy, and its relationship to celiac disease. Data were collected from 1,327 clinicians on a monthly basis between June 1998 and May 2000. The clinicians were asked to report all cases of newly diagnosed primary small bowel malignancy, and whether or not the patients reported also had celiac disease. Normally malignancies of the small intestine are rare, and they only account for less than 2% of all gastrointestinal cancers.
    Results: "Clinico-pathological data were ascertained for 395 cases, including 175 adenocarcinomas, 107 lymphomas and 79 carcinoid tumors. In 13% of adenocarcinoma cases and in 39% of lymphomas, there was a diagnosis of celiac disease. Survival rates at 30 months for adenocarcinomas, lymphomas and carcinoid tumors were 58%, 45% and 78%, respectively. Prognosis of all tumors was inversely related to stage at presentation, and lymphomas associated with celiac disease were associated with a poorer prognosis."
    This study provides more evidence that those with celiac disease run a greater risk of getting adenocarcinoma of the small bowel, as well as lymphoma. Because of the high rate of metastatic disease in the patients studied, there appears to be a long time from the onset of symptoms to diagnosis, which is a concern.
    Unfortunately this study does not address when celiac disease was diagnosed in these patients, and whether or not they were treating it with a gluten-free diet. Other studies have shown that cancer risk decreases to that of the normal population in patients who are on a gluten-free diet for at least five years.

    Jefferson Adams
    Celiac.com 09/17/2010 - People with celiac disease have higher risk for developing lymphoma and small bowel malignancy, though most studies have found no higher risk of colorectal cancer.
    To compare rates of colorectal cancer in celiac disease patients with rates for non-celiac disease control subjects, Dr. Peter Greene and colleagues at Columbia University Medical Center conducted a study. The research team included B. Lebwohl, E. Stavsky, and A. I. Neugut.
    For the study, the team reviewed case data for all celiac disease patients who underwent colonoscopy at Columbia Medical Center during a 44-month period. They matched each patient with non-coeliac disease controls according to age, gender and presiding endoscopist.
    They then compared rates of colorectal adenoma between the groups, and used multivariate analysis to rate any independent association between celiac disease and cancers (adenomas).
    The team found 180 patients with celiac disease and 346 controls. Thirteen percent of celiac patients and seventeen percent of control subjects showed at least one adenoma (P = 0.20).
    Multivariate analysis showed that age and male gender were associated with adenomas in both groups, but showed no connection between celiac disease and adenomas.
    More specifically, relative adenoma risk rose by 4% with each additional year of age, with men facing a 2.33-fold increased risk compared with women.
    Their data showed clearly that celiac disease is not associated with an increased risk of colorectal neoplasia. They also note that the lack of increased risk of colorectal cancer seen in population studies reflects a genuine average risk of colorectal neoplasia, rather than an increase in colonoscopies and associated polypectomies in people with celiac disease.
    Source:

    Aliment Pharmacol Ther. DOI: 10.1111/j.1365-2036.2010.04440.x

    Jefferson Adams
    Celiac.com 09/25/2013 - People with celiac disease have higher rates of lymphoproliferative malignancy. Currently, doctors just don't know whether risk levels are affected by the results of follow-up intestinal biopsy, performed to document mucosal healing.
    A team of researchers recently tried to find out if overall risk for lymphoproliferative malignancy in people with celiac disease is connected with levels of mucosal healing. The research team included Benjamin Lebwohl, MD, MS; Fredrik Granath, PhD; Anders Ekbom, MD, PhD; Karin E. Smedby, MD, PhD; Joseph A. Murray, MD; Alfred I. Neugut, MD, PhD; Peter H.R. Green, MD; and Jonas F. Ludvigsson, MD, PhD.
    The are variously affiliate with the Columbia University College of Physicians and Surgeons, New York, New York; Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden; Mayo Clinic College of Medicine, Rochester, Minnesota; and Örebro University Hospital, Örebro, Sweden.
    For their population-based cohort study, the team looked at data from all 28 pathology departments in Sweden. They evaluated at data for 7625 patients with celiac disease who received follow-up biopsy after initial diagnosis.
    Measurements: They used expected rates to assess risk for LPM, compared with that of the general population. They then used Cox regression to compare rates of LPM in patients with persistent villous atrophy against rates for patients with mucosal healing.
    Of the 7625 patients with celiac disease and follow-up biopsy, 3308 (43%) showed persistent villous atrophy. Overall risk levels for LPM were higher for celiac patients who had received biopsy (standardized incidence ratio [sIR], 2.81 [95% CI, 2.10 to 3.67]) than for the general population. LPM risk levels were higher for celiac patients with persistent villous atrophy (SIR, 3.78 [CI, 2.71 to 5.12]) than for those with mucosal healing (SIR, 1.50 [CI, 0.77 to 2.62]).
    Compared with mucosal healing, persistent villous atrophy was associated with an increased risk for LPM (hazard ratio
    , 2.26 [CI, 1.18 to 4.34]). Risk for T-cell lymphoma was higher (HR, 3.51 [CI, 0.75 to 16.34]), but not for B-cell lymphoma (HR, 0.97 [CI, 0.21 to 4.49]). One limitation of the study is that it gathered no data about patient adherence to a gluten-free diet.
    Higher risk for LPM in celiac disease is connected with follow-up biopsy results, with a higher risk among patients with persistent villous atrophy.
    Follow-up biopsy may be an effective way to classify celiac disease patients by risk for subsequent LPM.
    Source:
    Ann Intern Med. 2013;159(3):169-175. doi:10.7326/0003-4819-159-3-201308060-00006

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    Potatoes are good for breakfast! Your concoction sounds pretty good. K, how about this? Peel & dice potatoes, fry them in just enough olive oil to keep them from sticking in a skillet until they begin getting crispy. Toss in diced sweet peppers or maybe chili peppers, onions to soften. I know you're not doing egg yolks b/c of iodine but you can do the whites. Pour egg white on top until the white is done. If you have a steak or some leftover steak, you can heat that on the side. YUM!
    Hi Mom, I am so sorry you're getting the run around. Yes, the links worked for me too & that poor little thing! Cyclinglady gave you excellent advice. I really can't add anything to it but everything she says is right on. Keep advocating!  Read this: https://www.sjsreview.com/8752/features/sophomore-establishes-celiac-support-group/ I found how you can contact her. GenerationGF.Houston@gluten.org Here's the web page. Scroll down to the TX groups. https://gluten.org/k
    Wow!  I can say thank you in Polish, but can not spell it.  This is a bit off topic, but I will post this here and then open a new topic.   A month or so ago, a guest commented on an article that Celiac.com had published.  The guest mentioned that she has been a celiac for decades, long before the gluten free craze.  She noticed that she is now getting more gluten exposures compared to the years when there were very few gluten free processed foods on the market.  Interesting. With
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