Monday, March 16, 2009

Burkitt's Lymphoma: The Cure

Researchers in Great Britain have discovered how a dormant virus triggers Burkitt's Lymphoma.

Burkitt's Lymphoma is actually the result of a "genetic accident" that occurs in cells of the immune system, called B lymphocytes. Although this is a very rare occurrence, our body still has a natural defence mechanism for this, in the form of a cellular protein called bcl2. The bcl2 protein maintains the health of normal cells, which in turn prohibit the growth of the Burkitt's cancerous cells. The result is that the Burkitt's cells are kept in check, and the infected person will likely never know they have the cancerous cells.

Here is where the problem comes. There is a very common virus called EBV (Epstein-Barr Virus) which infects about 90% of children. In most cases EBV remains dormant and never displays any symptoms.

Scientists at Great Britain's University of Birmingham have now identified that if EBV comes in contact with the Burkitt's cells, the dormant EBV is activated and triggers a viral protein that fuels the Burkitt's tumor cells. This EBV protein looks and acts just like the cellular protein bcl2, whose job it is to maintain healthy cells.

It appears that this interaction sparks the growth of the Burkitt's cancer cells. The body responds by attempting to duplicate the bcl2 proteins, strengthening the healthy cells. Unfortunately the body mistakenly begins duplicating the false EBV proteins, effectively starving the healthy cells and strengthening the Burkitt's cells. The faster Burkitt's grows, the more the body produces the false EBV protein, fueling Burkitt's to grow even faster. The result is a cancer that grows at incredible speed, doubling its size every 16 hours. Once begun, Burkitt's Lymphoma spreads to virtually every major organ in the abdomen and chest within weeks. Then, as the immune system collapses, Leukemia steps in and quickly spreads through the bone marrow and central nervous system. If undiagnosed, Burkitt's can be fatal within 5 weeks.

So why does this matter to the rest of us ?

This is why. The standard treatment for most cancers, including Burkitt's, is chemotherapy. The basic premise of chemo is that cells that grow fast will die fast. Therefore we use chemo to inject incredible amounts of poison into the body to kill the fast growing cancer cells, while hopefully leaving enough healthy cells to sustain life. The process is a constant balancing act of trying to kill cancer while preventing major organ failures. Many fatalities are caused by the treatments themselves, and among survivors the treatments often result in life long side effects and secondary cancers. If you think the process sounds barbaric, you should visit a pediatric cancer floor. It is indescribable what these young people endure, and do so with incredible courage and dignity.

Here is the point: The cure for cancer will not be found in the destructive effects of chemo or radiation. The cure will be found in the fact that our bodies, when operating correctly, have the natural defenses to stop cancer. Cancer grows when something has stopped our body from producing the natural proteins that block the growth of cancer. The most promising research is in the area of finding exactly what went "wrong", and fixing that defect. With research we are learning how to activate the good cells and deactivate the problem cells.

New drugs are being created, referred to as "smart bombs", that are able to search and identify specific types of cells to either enhance or destroy them. One such drug is Bexxar. Burkitt's resides inside a protein within the white blood cells, called CD-20. Bexxar searches out and attaches itself only to those cells containing CD-20. It then self destructs, destroying both itself and the infected cell.

The problem with the new research is money. The research and development of a single one of these drugs is well over a billion dollars, but the U.S. government budgets only $30 million a year for the combined research of all childhood cancers. And price controls being placed on drugs have discouraged the pharmaceutical companies from investing the funds necessary to research these new treatments. Fear of malpractice litigation and insurance restraints have added to the problem. The result is that we are stuck with damaging chemo treatments, which have seen little improvement in over 30 years.

I do not have any great solutions to the problem. As I research it, it seems everyone just blames everyone else. Doctors blame insurance, insurance blames pharmaceutical companies, and the pharmaceuticals blame malpractice attorneys. All I know is that, as long as we continue to blame others, the solutions will never be found.

I appreciate that there is a lot of problems in our current health care system. But as I hear all the solutions, I am very concerned that we are focusing only on price controls. The truth is that there is no cheap fix to the cure for cancer. The cure to cancer will not be found by streamlining systems, cutting profits, and eliminating bonuses. I am not taking sides here on the political debate about health care. I am only stating that I hope we keep our focus on the goal. In our search for a solution to affordable health care, let us not forget to heal people. If we are not curing people, what have we really gained?


Lori said...

Thanks for sharing this very interesting information. I wonder if they have studied the relationship between leukemia (AML) & EBV. Cameron had a serious case of EBV just before he relapsed last summer.

Keeping your family in my thoughts.


Kyle Alfriend said...

Hi Lori-

There seems to be a connection between EBV and relapsed AML leukemia.

From what I have found, they have not yet made the specific connections, but EBV appears with relapsed AML in over half the cases. That number is much higher when a bone marrow transplant is involved.

There clearly seems to be a connection bewteen between the two.

Lori said...

Thanks Kyle. That is what I suspected. Cameron's EBV appeared within 2 months of his 2nd transplant. I don't know that not having this information at the time would have changed anything, certainly not the outcome.

Miles said...

Here's a link to the full article

I just wanted to mention that the researchers were mostly talking about the endemic form of Burkitt's and only some of the sporadic form that your son and my wife had. Recent studies peg the involvement of EBV with sporadic Burkitt's at 15-85% unlike the 100% involvement with the endemic.

SMASH said...

Thanks for sharing. My son has also had Burkitt's Lymphoma.