Guest guest Posted March 12, 2006 Report Share Posted March 12, 2006 I'm e-mailing the head hemo pathologist at NY hosp to ask the question - Hopefully she'll answer, she's always busy....... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 26, 2008 Report Share Posted March 26, 2008 , From the perspective of assessing clinical response, the time from treatment to time of progression is used. As you point out, this is not what translates into what is most important for the patient. It is believed that the two are related. So the longer until you progress, the longer until you need treatment. In general we discuss a response of less than six months or lack of a response as defining refractory disease. That is not necessarily the same as clinical benefit. A good example is a patient who receives only rituximab in order to help reduce splenomegaly and improve counts. The blood counts might not improve sufficiently to achieve a " response " , but with continued therapy every six months, the patient might be kept stable for years. Here there is a great clinical benefit without a response. When measuring the quality of therapies, it is important to be rigid. When deciding how to treat patients, obviously clinical benefit is what is most important. Rick Furman, MD Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 26, 2008 Report Share Posted March 26, 2008 -I asked my pulmonologist whether my pulmonary function tests would show, as Dr. Furman said, lymph node involvement if it existed. He answered that he thought he disagreed, and he enclosed my latest tests for Dr. Furman to determine what he could from them. I have pasted them below along with the technician's comment. Carolyn : " Date: 12/28/07 Brigham and Women's Hospital Pulmonary Function Laboratory 75 Francis Street Boston, Massachusetts 02115 Phone: (617)732-7424 Fax: (617)732-xxxx Medical Director: A. Kritek, M.D. Name: SWIFT,CAROLYN MRN: 04011524 Date of Birth: 11/10/28 Date of Test 12/28/07 Gender: Female Location: Center for Chest Height: 66 in Referring Physician: Fanta,Christophe Weight: 164 lb Attending Physician: PERRELLA,MARK AN Race: White Technician: HK998 Resp.Diagnosis: 493.90 Study Status: Final SPIROMETRY (BTPS) Predicted Pre-BD Post-BD Percent Range Change Mean 95% CI Actual %Pred Actual %Pred FVC (Lts) 2.95 2.27 1.79 61 FEV1 (Lts) 2.15 1.59 0.95 44 FEV6 (Lts) 2.77 2.04 1.66 60 FEV1/FVC (%) 73 64 53 73 FEV1/FEV6 (%) 78 69 57 73 FEF25_75 (L/s) 1.64 0.28 0.39 24 PEFR (L/s) 5.22 3.39 2.12 41 FET (Secs) 8.32 PHYSICIAN INTERPRETATION These data suggest a severe combined obstructive and restrictive ventilatory deficit. Suggest lung volumes if clinically indicated. Compared with Nov. 9, 2007 FEV1 has decreased 16% and FVC has decreased 24%. ________________________________________________________________________________\ ____ Never miss a thing. Make your home page. http://www./r/hs Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 26, 2008 Report Share Posted March 26, 2008 Carolyn, The idea would be if a lymph node was causing an obstruction versus obstructive airway picture suggestive of COPD that would explain you dyspnea. While one is the result of a lymph node compressing the airways, one might be due to chronic infections causing destruction of the walls of the alveoli. Rick Furman > > > -I asked my pulmonologist whether my pulmonary > function tests would show, as Dr. Furman said, lymph > node involvement if it existed. He answered that he > thought he disagreed, and he enclosed my latest tests > for Dr. Furman to determine what he could from them. I > have pasted them below along with the technician's > comment. Carolyn > > : " Date: 12/28/07 > > Brigham and Women's Hospital > Pulmonary Function > Laboratory > 75 Francis Street Boston, > Massachusetts 02115 > Phone: (617)732-7424 Fax: > (617)732-xxxx > Medical Director: A. > Kritek, M.D. > > Name: SWIFT,CAROLYN MRN: > 04011524 > Date of Birth: 11/10/28 Date of Test > 12/28/07 > Gender: Female Location: > Center for Chest > Height: 66 in Referring > Physician: Fanta,Christophe > Weight: 164 lb Attending > Physician: PERRELLA,MARK AN > Race: White Technician: > HK998 > Resp.Diagnosis: 493.90 Study Status: > Final > > SPIROMETRY (BTPS) > Predicted Pre-BD > Post-BD Percent > Range > Change > Mean 95% CI Actual %Pred > Actual %Pred > FVC (Lts) 2.95 2.27 1.79 61 > > FEV1 (Lts) 2.15 1.59 0.95 44 > > FEV6 (Lts) 2.77 2.04 1.66 60 > > FEV1/FVC (%) 73 64 53 73 > > FEV1/FEV6 (%) 78 69 57 73 > > FEF25_75 (L/s) 1.64 0.28 0.39 24 > > PEFR (L/s) 5.22 3.39 2.12 41 > > FET (Secs) 8.32 > > PHYSICIAN INTERPRETATION > These data suggest a severe combined obstructive and > restrictive ventilatory > deficit. Suggest lung volumes if clinically indicated. > Compared with Nov. 9, > 2007 FEV1 has decreased 16% and FVC has decreased 24%. > > > > ______________________________________________________________________ ______________ > Never miss a thing. Make your home page. > http://www./r/hs > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 26, 2008 Report Share Posted March 26, 2008 Dr. Furman, Thanks for the response. I think it is obvious from your posts that you believe that quality of life is what is most important for the patient. Dave > > , > From the perspective of assessing clinical response, the time from > treatment to time of progression is used. As you point out, this is > not what translates into what is most important for the patient. It is > believed that the two are related. So the longer until you progress, > the longer until you need treatment. > > In general we discuss a response of less than six months or lack of a > response as defining refractory disease. That is not necessarily the > same as clinical benefit. A good example is a patient who receives > only rituximab in order to help reduce splenomegaly and improve > counts. The blood counts might not improve sufficiently to achieve > a " response " , but with continued therapy every six months, the patient > might be kept stable for years. Here there is a great clinical benefit > without a response. When measuring the quality of therapies, it is > important to be rigid. When deciding how to treat patients, obviously > clinical benefit is what is most important. > > Rick Furman, MD > Quote Link to comment Share on other sites More sharing options...
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