Marginal Zone B-Cell lymphoma (MALToma) - Indolent B-Cell Non-Hodgkin’s Lymphoma - Hematology/ Onco

[@MedicosisPerfectionalis]

🦠Antibiotics Lectures: www.medicosisperfectionalis.com/ 📝 Download Notes: www.medicosisperfectionalis.com/

[@thavishagunaratne7415]

Marginal zone lymphoma (gastric MALToma) --> ttt: PPI + amoxicillin + clarythromycin

[@MedicosisPerfectionalis]

Excellent

[@AbhishekKeshri07]

my mom using anti Hpkit for maltoma as first line of treatment & composition is Ppi + Amoxicillin & Tinidazole ... Is it good or not .??

[@jamespark9070]

My sister's husband has it. Extranodal marginal zone B cell lymphoma. Thank you. This video is very good. Maybe he will got Ctx. CVP-rituximab. I hope lymphoma should be gone.

[@林詩恩-r9b]

Eradicate the Helicobacter pylori: first line treatment: bismuth quadruple therapy or concomitant of PPI, clarithromycin, amoxicillin, and metronidazole. If failed, use the salvage regimen, which has no antibiotics previously used. Mechanism of lenalidomine: immunomodulation, anti-angiogenesis, selective efficacy in cell that has deletion in chromosome 5, etc. The last 2 questions: C and C.

[@MedicosisPerfectionalis]

You are the best!

[@ThePathOfEudaimonia]

Splendid.

[@vevenaneathna]

I really like your answer from uptodate "In the United States, given the limited information on antimicrobial resistance rates, we generally assume clarithromycin resistance rates are greater than 15 percent unless local data indicate otherwise[10]. Data suggest that H. pylori antibiotic resistance rates are high worldwide." so basically triple therapy is the gold standard but the gold standard is garbage so therefore use quadruple therapy.... But in my opinion as a former pharmacist all of the treatments for h.pylori suck and the US insurance system does everything in its power to make sure patients experience every possible hurdle to successful treatment 1. Clarithromycin seems to be in every first line regime but has two problems: its the worse macrolide for the heart (qt prolong) and almost all midlevels and rural drs have been using z-pack's as the worlds best selling antiviral thus obliterating macrolide sensitivity 2. Tetracycline has been on back order for the past 5 years until recently and can cause a lot of ADE if used with poor renal function. It is pregnancy category D="dont use" and can cause contraceptive failure (similar to 90% of abx). It was fda approved before a lot of drug interactions were tested for and is ironically known to have its potency reduced by Pepto-Bismol when taken within~4hrs. As it is a drug in short supply there is only a few suppliers and its generic cost is ~150$ meaning 95% of insurance plans instantly block the rx and require a PA. early formulations were associated with esophageal erosion so it should be taken like a bisphos=dont lie down. providers are quick to switch to doxy and this isnt supported by guidelines or studies 3. PPI use is only recommended to be BID which most insurance plans block and require a PA if the days supply is more than 10 days in a year. That means if the pt is on state insurance and its illegal for them to pay cash the pharmacist is going to only give them 10/14 days because providers are horrible at completing PA's and all these drugs need to be taken together with perfect adherence. 4. Flagyl is metabolized to anabuse and causes severe n/v with any alcohol use. The only other available alternative Tinidazole is 350$ and is instantly blocked requiring a PA by every insurance plan ive ever billed. it also only comes in bottles of 20-30 so most pharmacies refuse to order it because the remainder will expire before it will be used, and that wipes out all of the profit margin on all of the prescriptions. the reason h.pylori is so hard to treat is you basically only get one shot at it with the one treatment that is covered by insurance after a half dozen PA's are done, and even then the prescriptions are usually required to be picked up one at a time over the period of a week as the PA's go through and all have to be started at the same time and need to be taken at various times throughout the day every 4-6hrs and most patients are incapable of following the complex directions, get a significant number of side effects, dont finish their abx course, and most providers do not understand the pharmacy side of things well enough to get the right PA's done in a timely manner.

[@canannlp1606]

by using aristotle's deductive reasoning, I can say that you sir are a awesome teacher

[@MedicosisPerfectionalis]

Thank you ☺️ I am not sure I used it correctly, LOL 😂

[@ThePathOfEudaimonia]

Inductive reasoning!

[@rukhsarkhan9967]

Patient symptoms point towards H.pylori infection, especially with culture and symptoms, explained. With biopsy results and B cell marker, it confirms H.pylori MALT. Since it is not diffused you'll use the classic triple therapy to eradicate H.pylori infection using PPI, Macrolide and antibiotic. (C, C)

[@amanullah2399]

I would suggest this channel for medical student , it's just perfect

[@lorimcintyre7793]

I was diagnosed with gastric malt lymphoma but was found negative for h pylori. I was treated with radiation and chemotherapy, how is it possible to get Malt without h pylori?

[@MedicosisPerfectionalis]

I am so sorry to hear that. It’s possible. H. pylori is not an essential association. Never give up! Keep fighting!

[@starrysky1588]

I hope you are doing good now!

[@ThePathOfEudaimonia]

Very good question. How are you doing, Lori?

[@GiAndrei97]

H. Pylori infection is treated with a triple therapy combination of PPI's + Clarithromycin + Amoxacillin or Metronidazole

[@faizankhan-jp2my]

Sir what is real pathogenesis that how actually an autoimmune disorder or a chronic infection is leading to b cell marginal zone lymphoma?

[@shimmer8289]

@faizankhan-jp2my personally in my case b4 I was dx I handled alot of asbestos that needed to be packed snd sent for testing. I wasn't provided gloves or mask with filter, plus I didn't know it was dangerous. I developed a tumor in my lung. There are other agents such as round up which although now banned I think was used on our food ie wheat etc. And more environmental factors. I agree constant inflammation can also be a trigger. Yours is a good question.

[@hh7184]

I've been sick 4 years,, lymphoedema in my left armpit 2 years ago... I'm going to an oncologist in a few days.

[@MedicosisPerfectionalis]

I wish you the best of luck! Please keep me updated!

[@hh7184]

@@MedicosisPerfectionalis thank you, kind sir. Your videos are very informational 😊

[@starrysky1588]

Heyyy what did your doctor tell? I hope you are doing good now!

[@DaliTozzi]

These videos are great! I work with oncology clinical trials and I'm learning a lot you ! thank you SO MUCH

[@MedicosisPerfectionalis]

Wow 🤩 Thank you 🙏

[@anaghanagarale6979]

6:54 why beta 2 microglobulinemia occurs here?

[@ThePathOfEudaimonia]

It's such a fascinating (and important) fact that sometimes we can treat a form of cancer with an antibiotic!

[@amanullah2399]

You are the best

[@sinzo7202]

1) a,c 2) c Pls reply right or not

[@MedicosisPerfectionalis]

1) C 2) C

[@ericmaloney3889]

Huh, never knew Sjogren's syndrome was associated with lymphoma. Just assumed it was yet another issue I had separate from the lymphoma, like my Raynaud's.

[@MedicosisPerfectionalis]

I am so sorry you’re going through this. I wish you the best of luck! Lymphoma is treatable! Anytime you have any questions, just let me know!

[@ericmaloney3889]

@@MedicosisPerfectionalis - Oh, I'm a professional cancer patient at this point. I had MZL in 2001, which the military lied to me following my biopsy and said nothing was wrong, despite putting the actual MZL diagnosis in my records. 2011 was first DLBCL diagnosis. R-CHOP cleared that up. 2015 was 2nd DLBCL diagnosis. RICE and autologous stem cells took care of that. And 2019 was my current MZL diagnosis. At that time, my oncologist said "It's the same cancer you had and 2001" and I was like "lol, wut?". Anyhoooo, I told them I was ready to be a guinea pig. Got rejected for Zuma5 study due to kidney damage from the 2015 treatments. Got in to the VLS-101 study, but got bounced after 9 treatments due to growth in my torso and groin. I mean, it cleaned my head and neck right up, which was great, so I was kind of bummed on that one. I just started taking Ibrutinib daily 3 days ago. So far, so good, though she tells me it tends to only be about 50% effective. As the saying goes though, time will tell!

[@MedicosisPerfectionalis]

You’re a hero! Keep it up!

[@ericmaloney3889]

@@MedicosisPerfectionalis - You guys are the heroes! You keep us alive ;) Researchers especially. I lost my dad to Hodgkins at (his age) 33. Had it not been for advances in medical tech, I could've seen the same fate myself in 2011.

[@gordengibson1]

The potential impact of excessive sugar consumption or alcohol intake on the progression of Marginal Zone B-Cell lymphoma, also known as MALToma, and Indolent B-Cell Non-Hodgkin's Lymphoma, is a topic of inquiry. Is it feasible to investigate whether these dietary factors could potentially accelerate the growth of these types of cancer, or has this already been established?

[@allitaliana6453]

You are awesome

[@mohitzambare]

Option C for both the questions.

[@KevinMiddleton]

A couple of differences I noticed with my treatment. As soon as it was diagnosed I was put on a treatment regimen. This is because even though it's an indolent lymphoma, it has a good chance to evolve into something really dangerous. I was treated with Ibrutnib + Rituximab followed by a Stem Cell Transplant.

[@sudipdas4889]

My mother is 40 years old suffering from rheumatoid arthritis for the last 18 years was recently diagnosed with Nodal Marginal zone lymphoma (III)and occlusion of Distal SMV .

[@SherienElBehery]

👏👍

[@centex7409]

I was treated with 21 doses of radiation to the bottom of my left orbital. I was never offered antibiotics.

[@doctorofmedicine1113]

How its pathogenesis is associated with Bcl10 and NF- kB

[@MedicosisPerfectionalis]

Sorry, but I don’t understand the question.

[@shimmer8289]

Excuse me i was reading your notes it said survival rate is median 7 to 10 years. I was dx with Malt in lung 8 years ago, still on watch and wait. My blood always cks out, the tumour hasnt grown im stage 1 i was told. Am i to expect to die in 2 years or are they averaging out that number by sll cases reported?

[@MedicosisPerfectionalis]

Median survival rate can predict survival in a population on average. It cannot accurately predict survival in a single individual.

[@shimmer8289]

@MedicosisPerfectionalis ya my oncologist said I'm likely to die of something else than this. Unless lightening strikes and it transforms to aggressive. Interesting video I liked the breakdown ty.

[@Teresa_JKB]

What does a positive FISH result for BCL6 gene rearrangement mean when combined with Marginal Zone B-Cell lymphoma?

[@saddamalgafsi6721]

"The patients displayed extranodal disease and did not demonstrate any striking clinical and histological differences when compared with MZBCL lacking BCL6 rearrangement. " source: pubmed.ncbi.nlm.nih.gov/9332330/

[@abduswamadabduswamad4439]

Answer is c for each question

[@rameeshas8120]

You're funny 😂😂😂😂❤️❤️

[@lissakolotova4387]

*Only 18* 👇👇👇 151459.loveisreal.ru

[@sepehrsh7925]

metonidazol or combination of metronidazol with Amoxicillin

[@mohammad.shokrolahi]

Great video but please decrease the add amount i had to switch on the add blocker :( even though i know i have to watch them or click on them to help your channel but its just too many

[@MedicosisPerfectionalis]

Thank you for your feedback!

[@shahi.n]

Very good classification & explain in good way if decrease advertisement between movie its can be very very good But overally its great

[@MedicosisPerfectionalis]

Thank you 🙏

[@fatmamkwaleadam6648]

Last question 1-c and 2-c

[@yatheeshkpyatheeshkp8587]

Q1.C Q2.C

[@safilotra]

c, c?

[@umarfarooqkhan8208]

Very good presentation

[@channelzho]

C,C

[@tammyslaughter9587]

This is very well done and informative, thank you. I was diagnosed 2 years ago with stage 4 splenic marginal zone lymphoma, because there is bone marrow involvement. Also Nodal, and Splenic MZL are the rarer subtypes of MZL. In the US now days B&R is more commonly used (Bendamustine and Rituximab) instead of single agent chemo. Actually I just recently did four single agent Rituximab treatments and my spleen shrunk back to normal size. Also you can’t biopsy the spleen unless pathologist does so after splenectomy and splenectomies are now considered old school since hematologist/oncologist really do not like splenectomy for first line treatments anymore.

[@sallybarcelos]

Hey, Tammy! I’ve been suffering from autoimmune diseases for the past 10 years, first it was autoimmune hemolytic anemia, then it was vasculitis, then idiopathic purpura thrombocytopenia. My spleen was very normal those past years, but last year it got bigger and I felt chest pain. I thought it was covid or a heart attack. I was actually with covid-19, but had no symptoms. The pain was due to the enlargement of the spleen. The diagnosis was very hard! No significant alterations on the bone marrow, nothing to confirm the diagnosis on the lymph node biopsy. The “diagnosis” came with a blood exam called immune feno type of peripheral blood (I’m translating this name from my original language, hope it is the same) which showed all the marks the video showed for lymphoma of B cells. Like you said, and I wanted to see that in the video, after a first treatment of 4 sessions of Rituximabe, and after 6 months, the cancer returned. One doctor said I should had the splenectomy, in the video it appears with a question mark. Some doctors says the only one who can give this diagnostic is the pathologist after the spleen biopsy. Other doctors say the lymphoma respond well to immunochemoteraphy Rituximab plus other drugs, also said in the video. I’ve decided for chemo, but it would be nice a second video for a follow up, right? Since this type of lymphoma is indolent and the “production of cells” (for a lack of medical knowledge) is slow, how chemo works in this case? Which is best? Splenectomy x imunnochemoteraphy. And more, when it all started I was only 28 years old. This lymphoma is common in older males, like, what???? So, just wanted to tell you my story to let you know you are not alone, and everything will be okay!

[@tammyslaughter9587]

@@sallybarcelos Hi Sally! I really appreciate your response, it is very interesting to hear others experiences in dealing with this not so common lymphoma. I too had chest pain and thought I might be having a heart attack but I would check my vitals and they were normal. Later when having scans a very enlarged lymph node was found behind my mediastinum which was causing the chest pain. I had a flow cytometry to establish the immunophenotyping, and a bone marrow biopsy which showed bone marrow involvement and a stage 4 diagnosis. My oncologist wanted to do Rituximab and the chemo Bendamustine but since I had already had so much chemo before in a prior stage 4 cancer 6 1/2 years ago I didn’t want anymore chemo. But the single agent Rituximab worked in shrinking my spleen and lymph nodes back to normal. After remission no longer works with R&B anymore usually the next line of treatment is RCHOP or EPOCH. Which is a cocktail of Rituximab and chemo. Splenectomy is generally not the first line of treatment anymore unless there’s extenuating circumstances because of risks of post op complications, it’s kind of considered old school since there are newer monoclonal antibody treatments such as Obinutuzumab and Ofatumumab, or sometimes Ibrutinib, and a newer promising treatment such as CAR T-therapies, or cell-based gene therapy, although it’s extremely expensive. There is a SMZL FB support group that is very helpful in obtaining information on newer trials, and therapies for people with our type of cancer and it’s very interesting to hear of other treatments from all over the world. You would be most welcome to join! I hope you are doing well and I’m so sorry you’ve had to go through this since you were very young. I’ve only had this for a few years and I can say it’s much easier than going through the stage 4 colorectal cancer I had 6 1/2 years ago. Take care, and best wishes!! 💕

[@MohamedMahmoud-gr8mn]

Answer is C , C

[@hedelabed5493]

Melillion kisses for you

[@MedicosisPerfectionalis]

Thank you 🙏

[@kemnana8740]

C, C

[@amanullah2399]

C and C

[@amanullah2399]

You are great

[@mareo91]

the answer is c,c >>>>and you were live in Egypt hmmmmm make sense XD