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What You Should Know Today

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In 1996, Doug Olson learned he had chronic lymphocytic leukemia (CLL), a type of cancer that starts in white blood cells. This cancer often grows slowly, so his doctor decided to watch it and wait to treat him.

But when Olson’s cancer started to grow a few years later, he had several rounds of chemotherapy. Then, in 2009, the tumor changed. Chemo no longer helped. Olson’s doctor, David Porter, MD, recommended a bone marrow transplant. But none of Olson’s siblings was a good match.

“It seemed like the news kept getting worse,” Olson says.

Then Olson’s doctor suggested a clinical trial for a new kind of cancer treatment. Specifically, it was a type of immunotherapy called CAR T-cell therapy. The aim: Re-engineer Olson’s immune cells in the lab to turn them into weapons to hunt down cancer cells.

CAR T-cell therapy may work when other treatments haven’t. And unlike chemo and radiation, which kill healthy cells as well as cancerous ones, immunotherapy targets the tumors with more precision.

CAR T-cell therapy, or CAR T, is one of a few types of immunotherapy. Each one works in a different way.

Doctors may turn to CAR T when T cells, which normally patrol the bloodstream to spot germs and other invaders, can’t recognize cancer as a foreign cell. That happens if the T cells lack the specific proteins that can bind to the tumor in order to attack.

It’s as if “the cancer cell has a piece of Velcro, but the patient’s T cells don’t have the corresponding piece of Velcro to make it stick,” says Porter, who is director of the Cell Therapy and Transplant Program at the University of Pennsylvania.

During CAR T-cell therapy, doctors first remove T cells from your body. Then they add a gene that makes the T cells produce special proteins called CARs (chimeric antigen receptors) on their surface, which can stick to the cancer cells. After the CAR T cells multiply in the lab, doctors put them back into your body.

The reengineered T cells “have been educated to recognize and kill the tumor cells,” says Renier Brentjens, MD, PhD, professor of medicine and director of the Cell Therapy Service at Memorial Sloan Kettering Cancer Center.

Not only that, the T cells “expand by 1,000- to 10,000-fold in the body.  And every one of those cells can go on to kill more cancer cells,” Porter says.

Olson received three doses of CAR T cells. After a couple of weeks, almost 20% of his white blood cells were CAR T. When he returned to Porter for tests, “he told me they couldn’t find a single cancer cell in my body,” Olson recalls.

The FDA approved the first CAR T-cell therapy in 2017. To date, the agency has approved two CAR T-cell therapies for cancer.

Axicabtagene ciloleucel (Yescarta). This is approved for B-cell lymphoma in adults that hasn’t responded to other treatments or has come back after treatment.

Tisagenlecleucel (Kymriah). This has the same approval as axicabtagene ciloleucel, but it also can be used to treat children and young adults with acute lymphoblastic leukemia.

In studies, 9 out of 10 people with acute lymphoblastic leukemia whose cancer didn’t respond to other treatments or whose cancer came back had full remission with CAR T-cell therapy. Remission means the cancer can’t be found in tests.

Complete remission rates for chronic lymphocytic leukemia and non-Hodgkin’s lymphoma are lower — 35% to 70%. Of that number, about a third have long-lasting remissions. “For those people it absolutely lives up to the promise,” Porter says.

But the catch is that remissions aren’t always permanent, Brentjens says. In many cases, doctors don’t know why the cancer returns. It could be that CAR T cells may not last long in the body. Or they may eventually get overtaken by a group of T cells that don’t have the protein that can chase down the cancer.

You won’t have hair loss that commonly follows chemotherapy. Instead, CAR T-cell therapy can lead to a short-lived but severe reaction called cytokine release syndrome, or CRS.

“It is similar to having a horrible case of the flu,” says Terry Fry, MD, a cancer researcher and professor at Children’s Hospital Colorado.  

Cytokines are proteins that immune cells release when they attack an infection. Symptoms include a high fever, nausea, chills, headache, rash, and trouble breathing. CRS can be deadly, but it’s treatable in a hospital.

CAR T-cell therapy also can affect the brain, causing confusion, trouble speaking, and sometimes seizures. Usually, Fry says, those symptoms happen within in a couple of weeks after the infusion and get better in about a month.

It’s been less than a decade since the first person received CAR T-cell therapy. So doctors still don’t know about any long-term risks.

CAR T-cell therapy works for blood cancers. But so far, it hasn’t been able to treat solid tumors like breast or lung cancer.

Leukemia and lymphoma cells are easier to hunt down because the targeted protein is on the surface, and because they’re not on healthy cells.

Fry says “solid tumors are a tougher nut to crack” because it’s harder to distinguish between targeted proteins that are on cancer tumors and those on healthy tissue. 

Brentjens is one of the researchers who is looking at ways to get around this and other hurdles.

“I’m an optimist, so I would say in the next 5 to 10 years we might have some CAR T cells that might be able to target some solid tumors,” he says. “But this is still very much a work in progress.”

Although there is still work to be done, CAR T-cell therapy has been a lifesaving treatment for many of the people who’ve received it. “A significant proportion of patients treated with these CAR T cells will be long-term survivors. And the patients we’re treating are the ones whose survival expectation was slim to none,” Brentjens says.



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Preteens and skincare: What parents should know – CHOC

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Published on: April 16, 2024
Last updated: April 9, 2024

Should teens and preteens be using so many skincare products with fancy ingredients? A pediatric dermatologist answers parents’ questions.

Link: https://health.choc.org/preteens-and-skincare-what-parents-should-know/



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Living With Crohn’s: My Daily Routine

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By Michelle Pickens, as told to Danny Bonvissuto

As early as I can remember, I’ve had issues with my health. When I was little, I had severe constipation, nausea, vomiting, and food sensitivities.

As I got older, those symptoms transitioned into diarrhea, irregular bowel movements, and pain. I was always very fatigued and my immune system was weak: The second someone in my class had the cold or flu, I’d get it, too. Looking back, it was a sign.

From a mental perspective, my anxiety was high. What if I need to find a bathroom? What if I’m nauseous? Doctors would say, “Oh, you’ll grow out of it. It’s just your anxiety.”

Finally, a Diagnosis

After years of misdiagnosis, I was finally diagnosed with Crohn’s disease in 2015. I was 23 and had just finished up college while working full time. My symptoms were getting worse. I had a lot of vomiting and pain. The fatigue was at the point where it was difficult for me to work or even get out of bed some days.

It was so bad it pushed me to seek additional care. I took a couple months off, looked for another job, and went through all the doctor appointments it took to get the diagnosis.

There’s no blood test for Crohn’s. No way to prove what you’re feeling. Eventually I saw the right doctor, who did a test with a pill camera called a small bowel capsule. (This is a pill-sized camera that you swallow, allowing doctors to see inside your digestive system.) It tracked my intestines and was able to get into a blind spot where neither a colonoscopy nor endoscopy can see inflammation. 

It was such a relief to get the diagnosis because it made me feel like I wasn’t crazy. For so many years I knew something was wrong and couldn’t name it. I also felt hopeful. Once I knew what I was dealing with, I knew I could work to get to a better place.

Sharing My Story

In 2016, I started a blog called Crohnically Blonde as an outlet to connect with people as I go through the stages of dealing with Crohn’s. When I first started to share, there weren’t as many people talking about it.

I’ve been able to form relationships in an online community through shared experiences. I hope someone can see my story and feel that, if they’re at the beginning of their journey, there’s a way to get through.

Managing My Medication

At first, I was on a lot of medication that wasn’t working well and was a huge imposition on my schedule. Now I get infusions of an immunosuppressive drug every 7 weeks.

It means being away from my family and job for 4-5 hours, and managing child-care coverage during the treatment and the weekend after, because I feel almost flu-like. The extra help allows me to rest and fuel back up after the treatment.

I have the option to be on more medications to control my symptoms. But I try to shy away from those and manage it on my own because I don’t want to be on medicine for every single thing.

Before I had my son, I was more willing to try different medications. But while I was pregnant, I could barely be on any of the Crohn’s medicines. After I had him, it didn’t make sense to be reliant on them.

Crohn’s, Pregnancy, and Motherhood

Crohn’s affected me throughout my pregnancy. I got very sick in my third trimester because I went off my immunosuppressive drug to avoid passing any on to the baby. I ended up having to be induced early so I could get back on the medication as soon as possible.

My son, Maddox, is 1 now. Crohn’s changed my expectation of what I thought motherhood would be.

I’ve learned that I’d rather be present and able to enjoy him in the good moments than push it when I’m sick. It’s been difficult. But if I’m not well, I can’t be there for my child. I try to be with him as much as I can, but there are times when I need to step back and take an hourlong nap.

I have a great support system: My husband, mom, or mother-in-law can step in and help out for a little while, and when I feel better, I can be a better mom. There are also days when I don’t have accessible help. In those situations, I’ll do lower-key activities that I can enjoy with him but that aren’t physically demanding on me.

Schedule and Adjust

Right now I’m in a pretty good spot. I work from home now, as a recruiter for a tech company, and that makes a huge difference. A lot of my anxiety in the past was around being in an office and being sick. Now that I can work remotely, it’s such a game changer.

But Crohn’s still affects my day-to-day. I have days where I’m feeling sick, and need to rest and change my plans so I’m home and not out somewhere.

No matter how planned-out I have my day or week, if I’m not feeling well that takes precedence. I like to be a very scheduled person. But I have to roll with the punches and have a plan B.

The biggest challenge is managing my sleep and stress. They’re both very influential in symptom flare-ups. I have to get at least 8 hours of sleep, no matter what. And I try to incorporate time to de-stress, like reading a book or relaxing at the end of the day.

Going to therapy helps offset stress as well, and is now part of my ingrained self-care schedule.

Social Life Strategies

My co-workers, family, and friends are very understanding. But that wasn’t the case at first. The more open I’ve been about Crohn’s, the more people understand that I’m not flaking out if I have to change plans; there’s an underlying reason.

I only have a certain amount of energy, so now I pick and choose. I know I need to work and be with my family, which means I have less energy to put into social situations.

I plan out what I’m comfortable doing, but have also become comfortable with changing plans. Even if I’m excited to go out to dinner with a friend, I don’t push it if I feel terrible that day.

Food in Flux

I’ve followed a gluten-free diet for years. I started with an elimination diet and realized that gluten was bothering me.

Other foods aren’t as black and white. I can eat a salad one day and it’s fine, and eat the same salad the next day and it makes me sick. I repeat the safe foods that don’t make me sick and stick to a general schedule of three meals a day that are pretty much all gluten free.

Sometimes the timing matters: I’ll wake up and feel nauseated and need a starchy food like dry cereal. If I’m going on a road trip, or have a big event, like a wedding, I plan it out and try to be careful about what I eat leading up to it because I don’t want to be sick. But it’s hard because you never really know. It’s kind of a gamble.

Flexibility Is Key

I’ve learned to be as flexible as possible. I never know what each day is going to bring, I just have to trust that my body is telling what it needs for that specific day. That’s my priority, and everything else can wait.

 



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The PowerBlock Adjustable Dumbbells That Shoppers Say Are 'Better Than BowFlex' Are $89 Off Right Now

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Men’s Journal aims to feature only the best products and services.  If you buy something via one of our links, we may earn a commission.

Adjustable dumbbells are an integral piece of fitness equipment to have in a functioning home gym, as they can be used for working on the chest, arms, shoulders, and many other muscle groups. The sweepingly popular BowFlex SelectTech 552 has been the choice of many for over a decade, but the price has shot up in recent years. If there’s another brand to know about, it’s PowerBlock, which packs just as much power and convenience as BowFlex dumbbells but for less—and now its bestselling set is on sale.

The PowerBlock Elite EXP Adjustable Dumbbells are on sale for $360 on Amazon—a 20% discount on the normal $449 price. These squared-off dumbbells have earned more than 1,700 five-star ratings from shoppers who have gone as far as saying they’re “better than BowFlex,” maker of the iconically popular SelectTech adjustable dumbbells

PowerBlock Elite EXP Adjustable Dumbbells, $360 (was $449) on Amazon

Courtesy of Amazon

Get It

The PowerBlock Elite EXP adjustable dumbbells offer a range of weights from 5 to 50 pounds in a slim, rectangular form that’s unlike any other model. The handle sits inside a cage-like design that’s padded with thick foam to protect and stabilize your forearms when lifting. Adjusting the weight is simple, too: Just use the color-coded guide on the top of the dumbbell to pick your weight, remove the magnetic selector pin, and pop it through the weight plate of the corresponding color. Once your weight is selected, everything is locked into place until you remove it again. What’s even better is that, once you’ve graduated from 50-pound weights, PowerBlock offers two expansion weights to build on your existing set.

Those who have brought PowerBlock’s adjustable dumbbells into their home gyms have raved about the high-quality build, the comfort, and their compact design, but many obsess over how easy they are to use. “I did quite a bit of research before pulling the trigger on these, but they’re exactly what I needed,” one shopper stated. “These are very easy to use. Changing weights takes me maybe 30 seconds between sets. They’re super compact and easy to store, too.” Another shopper agreed, simply stating that they’re “the most versatile, easy, and well-built that I have used.”

Many shoppers also praised the design of these dumbbells, specifically how their length is relative to the weight you select. “The weights feel great in the hand, and it is smaller when you’re using less weight as opposed to the BowFlex 552, which has the same length throughout,” one shopper described. Another shopper pointed out that with longer, fixed-length dumbbells, you “cannot get [them] close together when doing chest exercises,” but this model will allow you to achieve that complete motion.

PowerBlock adjustable dumbbells are a fine choice to feature in your home gym because of their ease of use, comfort, and design, but they’re even more of a no-brainer now that they’re on sale for just $360 and more affordable than the BowFlex SelectTech 552. We’re not expecting them to sell out, but the price could shoot back up at any time, so make sure to take advantage of the $89 savings and pick yours up soon.



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