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Jia Ruan, MD, PhD
JiaRuanMDPhD (Physician - Oncology - Hematology/Oncology (Verified) )| Communities: Non-Hodgkin Lymphoma , Hodgkin Lymphoma , CLL (Chronic Lymphocytic Leukemia) , Myeloma | Answers: 8 |
| Member Since: Jul. 2012 |
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Professional Statement
Jia Ruan, M.D., Ph.D., is an Assistant Professor of Medicine in the Division of Hematology and Medical Oncology at Weill Cornell Medical College. Dr. Ruan graduated summa cum laude from Washington University in St. Louis. She received comprehensive training in medicine and immunology leading to combined MD-PhD degrees from the Tri-Institutional Medical Scientist TrainingProgram of Cornell University, the Rockefeller University and Sloan-Kettering Cancer Institute. She completed internship and residency in internal medicine and started a clinical fellowship in Hematology at the Stanford University Medical Center. Returning to Cornell, Dr. Ruan completed a fellowship in Hematology and Medical Oncology at the New York Presbyterian Hospital. She is a member of the American Society of Hematology and the American Society of Clinical Oncology. Dr. Ruan's clinical practice includes patients with lymphoma, myeloma, and other hematological disorders.
Following her long-standing interest in tumor immunology and vascular medicine, Dr. Ruan is actively involved in translational research on tumor angiogenesis, and development of novel anti-angiogenic therapies in lymphoma and myeloma. Her current research efforts are recognized and supported by competitive fundings from Cornell CARCC, the Lymphoma Research Foundation, the ASCO Foundation Young Investigator Award and the ASCO Foundation Junior Faculty Career Development Award, in addition to the K08 Clinical Scientist Career Development Award from the National Institute of Health (NHLBI).
Following her long-standing interest in tumor immunology and vascular medicine, Dr. Ruan is actively involved in translational research on tumor angiogenesis, and development of novel anti-angiogenic therapies in lymphoma and myeloma. Her current research efforts are recognized and supported by competitive fundings from Cornell CARCC, the Lymphoma Research Foundation, the ASCO Foundation Young Investigator Award and the ASCO Foundation Junior Faculty Career Development Award, in addition to the K08 Clinical Scientist Career Development Award from the National Institute of Health (NHLBI).
Professional Info
Credential: MD
Primary specialty: Oncology - Hematology/Oncology
Medical school: Cornell University Medical College
Residency: Stanford University Hospital
Internship: Stanford University Hospital
Fellowship: New York Presbyterian Hospital - Cornell Campus
Practice address:
525 East 68th Street Payson Pavilion, 3
New York, NY
10065
Practice phone number: (646) 962-2064
Webpage:
http://www.weillcornell.org/jruan/
JiaRuanMDPhD Activities
Both autologous (from self) and allogeneic (from others) stem cell transplant (SCT) have been used in mantle cell lymphoma. Autologous transplant is often considered as a consolidation measure for patients younger than 65 years of age who have achieved a good response with frontline chemotherapy-based regimen. Data from European MCL registry and studies in US have shown that autologous SCT can maintain an additional 2-3 years of remission following frontline treatment such as R-CHOP. A majority of patients, however, will eventually relapse from their disease following autologous SCT. Allogeneic SCT are generally considered for patients with HLA-matched donors who have relapsed diseases. Given the significant treatment-related toxic side effects associated with bone marrow transplant, consultation with an established bone marrow transplant group with a clinical focus on lymphoma should be encouraged.
New answer by JiaRuanMDPhD (Physician - Oncology - Hematology/Oncology (Verified))
1
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9 months ago
As we discussed earlier, MCL tends to run a relapsing course. Managing patients with recurrent or progressive disease after first line therapy is a major component of practice for specialists who care for lymphoma patients. There are many options, both chemotherapy-based, and biologics, that are available for patients whose lymphomas progress after the first line of treatment. The general principle of chemotherapy-based salvage therapy is to apply new combination that the tumors may still be sensitive to. The list of notable biologic options includes bendamustine, bortezomib and lenalidomide, among others. Again, I would highly recommend that patients participate in well-designed clinical trials. One sample of a promising targeted therapy for MCL is a compound called BTK Inhibitor PCI-32765 which is in phase II clinical trials. There are many such examples available in major lymphoma research centers.
New answer by JiaRuanMDPhD (Physician - Oncology - Hematology/Oncology (Verified))
1
Answer |
9 months ago
During treatment, the medical oncologists and their teams work very closely with the patients to monitor [1] response to therapy, and [2] potential treatment-related toxicities. Response assessment would follow all aspects of disease involvement, and typically include physical exam to see if palpable lymph node or spleen enlargement has decreased, blood tests to evaluate whether blood counts have improved, and periodic CT or PET scan to measure changes in lymph node / spleen sizes. For patients who have resolved all measurable disease on the scans, their oncologists may propose to repeat a bone marrow biopsy (if the bone marrow was initially involved by disease) in order to document complete response. In the meantime, evaluation of side effects is equally important to determine if the treatment is safe for a particular patient, and whether modification of medication dosage or treatment schedule is warranted.
New answer by JiaRuanMDPhD (Physician - Oncology - Hematology/Oncology (Verified))
1
Answer |
9 months ago
As you know, there is no standard first line of treatment for mantle cell lymphoma. Because there is no cure at present, the treatment goal is aimed at controlling symptomatic disease, preserving quality of life and extending survival. There are many effective agents available for first line treatment, each having different durability of response and toxicity profiles. For example, the combination of CHOP plus rituximab (R-CHOP) is commonly employed and generally well-tolerated, which provides a median duration of response of 16 to 20 months. The combination of rituximab plus bendamustine is another popular regimen which may have better duration of response than R-CHOP in patients who have chemo-sensitive disease. Rituximab plus HyperCVAD regimen is a more intensive treatment option that often requires hospital stay and can be quite toxic, especially for patients who are over 65 years of age. High dose chemotherapy followed by autologous stem cell transplant can be considered for younger patients with good performance status in order to prolong the response duration following frontline chemotherapy.
Our group at the Center for Lymphoma and Myeloma of Weill Cornell Medical College has championed low-intensity approach for elderly lymphoma patients, especially those who have slow-growing (based on clinical evaluation and pathology Ki-67 rate) and asymptomatic disease. Watchful waiting can be a reasonable initial option for these patients without affecting their survival or subsequent treatment response, as long as they are followed closely by the oncologists. In addition, patients are encouraged to seek out novel therapies offered at major lymphoma centers. We are currently conducting an investigator-initiated clinical trial to evaluate whether biologic compounds alone, namely the combination of lenalidomide plus rituximab, without the need for chemotherapy, can induce clinical response in the frontline setting for MCL (clinicaltrials.gov, NCT01472562). The purpose of the study is to test the synergy of combining lenalidomide, a biological agent that targets the tumor microenvironment including angiogenesis, and rituximab, an antibody that targets lymphoma cells. This study has a maintenance phase of lenalidomide and rituximab therapy following initial induction treatment, aimed at improving durability of response.
Our group at the Center for Lymphoma and Myeloma of Weill Cornell Medical College has championed low-intensity approach for elderly lymphoma patients, especially those who have slow-growing (based on clinical evaluation and pathology Ki-67 rate) and asymptomatic disease. Watchful waiting can be a reasonable initial option for these patients without affecting their survival or subsequent treatment response, as long as they are followed closely by the oncologists. In addition, patients are encouraged to seek out novel therapies offered at major lymphoma centers. We are currently conducting an investigator-initiated clinical trial to evaluate whether biologic compounds alone, namely the combination of lenalidomide plus rituximab, without the need for chemotherapy, can induce clinical response in the frontline setting for MCL (clinicaltrials.gov, NCT01472562). The purpose of the study is to test the synergy of combining lenalidomide, a biological agent that targets the tumor microenvironment including angiogenesis, and rituximab, an antibody that targets lymphoma cells. This study has a maintenance phase of lenalidomide and rituximab therapy following initial induction treatment, aimed at improving durability of response.
New answer by JiaRuanMDPhD (Physician - Oncology - Hematology/Oncology (Verified))
1
Answer |
9 months ago
Several clinical and pathological parameters have been shown to be useful to determine the clinical aggressiveness of mantle cell lymphoma, although none of them are perfect. A well-known clinical index is called international prognostic index (IPI), which incorporates information about the patient’s age, LDH, stage, extranodal involvement and performance status. IPI was initially developed for patients with aggressive NHL. A score of 4-5 defines high risk, a score of 2-3 defines intermediate risk, while a score of 0-1 goes with low-risk. More recently, a prognostic index called MIPI (mantle cell lymphoma IPI) was developed specifically for patients with mantle cell lymphoma, which provides a weighted score based on patient’s age, performance status, LDH and white blood cell count. High risk is for an MIPI score over 6.2, low risk is for a score less than 5.7, and intermediate risk for a score in between. Patients with low- and intermediate-risk MIPI scores tend to have more slowly growing disease, and tend to do better with treatment, while those high MIPI scores tend to have more symptomatic disease. Some of recent clinical trials have provided evidence for MIPI score as a better predictor of outcome than the IPI score. Another useful parameter to gauge the clinical behavior of MCL is based on a pathologic scoring of growth rate of tumor cells, known as the Ki-67 rate, named after the nuclear protein Ki-67 that is associated with cellular proliferation. Ki-67 has showed high prognostic relevance for overall survival in MCL patients, independent from clinical factors such as IPI or MIPI. The most favorable survival outcome appears to be associated with Ki-67 rate less than 10%.
New answer by JiaRuanMDPhD (Physician - Oncology - Hematology/Oncology (Verified))
1
Answer |
9 months ago
Angiogenesis refers to the growth of new blood vessels, which is critically important to support the growth of tumors. Most of our knowledge on this topic has come from experiences with solid tumor cancers, for example colon cancer, lung cancer, and breast cancer. However, there are ongoing research interests and efforts to try to understand how angiogenesis can be involved in lymphoma growth and progression, and then how we could apply that knowledge to improve treatment. Our lymphoma group has been an active participant in the research activities. There are already promising clues. For example, [1] several studies found that lymphoma cells could produce growth factors that directly stimulate the growth of endothelial cells and increase the amount and density of blood vessels surrounding the tumors; [2] some lymphoma cells could produce additional soluble factors to attract blood cells such as monocytes / macrophages which in turn help to build more blood vessels; [3] scientists were able to perform high-tech gene expression studies using banked lymphoma specimens from patients with follicular lymphoma and diffuse large B-cell lymphoma (DLBCL) to show that non-tumor cells residing in the same neighborhood with the tumors (which also known as the microenvironment) can determine the disease outcome. In the case of DLBCL, these non-tumor cells may act as enablers by building a blood-vessel rich neighborhood which may insulate the tumor cells from conventional therapy. These studies have inspired additional investigations for basic research and clinical trials. Examples of biologic agents undergoing evaluation for their anti-angiogenic potentials include monoclonal antibodies against growth factors such as vascular endothelial growth factor (VEGF), immunomodulatory agents such as lenalidomide / thalidomide, among others. The most important tasks facing lymphoma angiogenesis community are to define lymphoma subtypes that may benefit from anti-angiogenic treatment, and to search for targets within the microenvironment that would respond to anti-angiogenic intervention.
New answer by JiaRuanMDPhD (Physician - Oncology - Hematology/Oncology (Verified))
1
Answer |
9 months ago
CHOP is the acronym for the chemotherapy combination consisting of cyclophosphamide, doxorubicin, vincristine and prednisone, which is the most commonly used regimen in lymphoma treatment, for both B-cell and T-cell non-Hodgkin’s lymphoma. It is typically administered every 3 weeks as an outpatient treatment in either a doctor’s office or an infusion center. The duration of treatment is determined by the disease stage and the response to treatment. Common side effects to monitor include low blood counts, hair loss, neuropathy and infection. Cardiac function needs to be monitored, especially in patients with pre-existing cardiac conditions.
The combination of CHOP plus rituximab (R), an monoclonal anti-B-cell CD20 antibody, has become the standard treatment for patients with diffuse large B-cell lymphoma, with two thirds of treated patients going on to be cured. R-CHOP is also commonly used for initial treatment of patients with mantle cell lymphoma. However, the median duration of response following R-CHOP is only about 16-20 months for patients with MCL.
The combination of CHOP plus rituximab (R), an monoclonal anti-B-cell CD20 antibody, has become the standard treatment for patients with diffuse large B-cell lymphoma, with two thirds of treated patients going on to be cured. R-CHOP is also commonly used for initial treatment of patients with mantle cell lymphoma. However, the median duration of response following R-CHOP is only about 16-20 months for patients with MCL.
New answer by JiaRuanMDPhD (Physician - Oncology - Hematology/Oncology (Verified))
1
Answer |
9 months ago
Mantle cell lymphoma (MCL) is a rare but distinct subtype of B-cell non-Hodgkin’s lymphoma (NHL), representing 5-8% of NHL. Pathologically, it has a characteristic genetic translocation t(11;14)(q13;q32) which overproduces cyclin D1, a cell cycle protein. The t(11;14) can be reliable detected by fluorescence in situ hybridization (FISH), and cyclinD1 by immunohistochemistry. These 2 tests are included in the standard panel for definitive diagnosis in conjunction with routine histology, immunohistochemistry and immunophenotypic flow studies. Clinically, mantle cell lymphoma affects more male than female (ratio 3:1), and the mean age at diagnosis is around 68 years. Most MCL patients present with advanced stage disease (stage 3 & 4), and up to 25% can present with extranodal disease which typically involves gastrointestinal tract.
Mantle cell lymphoma must be differentiated from other subtypes of non-Hodgkin’s lymphoma which are composed of small to medium sized cells, including chronic lymphocytic leukemia (CLL/SLL), follicular lymphoma (FL) and marginal zone lymphoma (MZL). In contrast to MCL B-cells which are positive for CD5, negative for CD23, and express cyclin D1, CLL cells are positive for both CD5 and CD23, but negative for cyclin D1, while FL and MZL cells are generally negative for CD5 and do not express cyclin D1. Since the clinical management for MCL can be different from other NHL subtypes, I would like to emphasize the importance for patients with newly diagnosed MCL to get a second opinion / confirmation from a lymphoma center with expertise in hematopathology.
There is a wide range of clinical behaviors for mantle cell lymphoma. Some patients can present with very indolent disease despite having advanced stage, and can be managed by conservative observation without cytotoxic treatment initially. Others may present with rapidly progressive disease that requires immediate systemic chemotherapy. Unlike certain kind of aggressive lymphoma, such as diffuse large B-cell lymphoma or Hodgkin’s lymphoma, which can be cured in a majority of patients, mantle cell lymphoma remains incurable. Therefore, individualized approaches to maximize survival and maintain quality of life are important treatment goals.
Mantle cell lymphoma must be differentiated from other subtypes of non-Hodgkin’s lymphoma which are composed of small to medium sized cells, including chronic lymphocytic leukemia (CLL/SLL), follicular lymphoma (FL) and marginal zone lymphoma (MZL). In contrast to MCL B-cells which are positive for CD5, negative for CD23, and express cyclin D1, CLL cells are positive for both CD5 and CD23, but negative for cyclin D1, while FL and MZL cells are generally negative for CD5 and do not express cyclin D1. Since the clinical management for MCL can be different from other NHL subtypes, I would like to emphasize the importance for patients with newly diagnosed MCL to get a second opinion / confirmation from a lymphoma center with expertise in hematopathology.
There is a wide range of clinical behaviors for mantle cell lymphoma. Some patients can present with very indolent disease despite having advanced stage, and can be managed by conservative observation without cytotoxic treatment initially. Others may present with rapidly progressive disease that requires immediate systemic chemotherapy. Unlike certain kind of aggressive lymphoma, such as diffuse large B-cell lymphoma or Hodgkin’s lymphoma, which can be cured in a majority of patients, mantle cell lymphoma remains incurable. Therefore, individualized approaches to maximize survival and maintain quality of life are important treatment goals.
New answer by JiaRuanMDPhD (Physician - Oncology - Hematology/Oncology (Verified))
1
Answer |
9 months ago
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