What's new in CLL as per the recent ASH conference in Atlanta

[Guest guest]

Friends - if you get this e-mail twice, I apologize, it means that I have you on my CLL Info Group (CIG) list and you are also on the discussion CLL/SLL group. But I do not want to miss anyone.

The following is a summary of what Dr. O'Brien of MDA had to say during her brief 25 minutes on the Cancer Care LLS conference today (I don't know why they always cut these so short.)

The ASH conference is a big deal, I understand that 4000 papers were presented. Dr. O'Brien wisely chose to limit her remarks to only a few subjects.

(BTW, transcripts will be available on the LLS web site in January.)

Before beginning, she chose to address two questions that have been asked of her a great many times.

1. Is watch/wait still the gold standard?

Her answer was basically YES, except that now they check new patients for prognostic indicators (mutations of IGVH, status of CD38, ZAP70, chromosomal abnormalities, etc). The idea is to identify early whether or not W/W is the right approach, or whether patinets with bad prognostics might benefit from earlier TX.

Therefore a study is in progress where they look at people with poor prognostics, particularly IGVH, and compare the results of chemo naive patients on W/W or on FR.

This trial is available in many places, the object being to determine whether, if you have bad prognostic indicators, you might not be better off being treated rather than W/W.

Results are not yet complete, but they suspect that actual survival might be increased if they get the right answer to this question.

2: Should you get swine flu vaccine?

Yes, it will not hurt you (do not get the live vaccine spray, get the dead injection vaccine). But, do not expect too much. The screwed up immune system will create a less good response to the vaccine that a healthy immune system would, so you might not be as protected as you think. But, there is no down side, so why not?

Continue to take the usual precautions, hand washing, etc.

Then Dr.O'Brien launched into the ASH conference itself, but she chose to focus on several issues, even though she said that MANY things were presented. So if some of you are interested in a particular issue, you might want to go to the site that Dr. Furman suggested yesterday

1. As first line TX she discussed FC, FR, and FCR. She pointed out that it has been shown that there is actually a survival advantage with FCR vs. FC.

Also, that there is currently a widely available trial comparing FCR, FR, and FR + Revlimid. (We'll talk about Revlimid later). This is a fully randomized trial, available in many places. This is aimed primarily at first line TX.

2. Dr. O'Brien spoke about the newly approved bendamustine (Treanda), and pointed to a German trial for chemo naive people reporting a 90% OR (OR = CR + PR) with bendamustine + Rituxan. (She mentioned that almost every TX, if R is added to it, improves the results.)

3. Revlimid - lenalidomide - I was happy to have this mentioned - the drug is taken orally, and there is a trial going on for relapsed patients. The OR is 70%, especially if (no surprise) Revlimid is combined with Riruxan, There are many other Revlimid related trials, but they are more localized and might require travel.

4. Finally, Dr. O'Brien discussed ofatumumab, "the son of Rituxan". This is given by infusion, has very few side effects, and has been given in trials as a single agent for people refractory to F. Ofatumumab is easy to take with few side effects, only infusion related, like R. In front line therapy this TX has shown an OR of 80% and a CR of 50%.

They are starting a trial with FC + ofatumumab, so far it shows similar results to FCR.

Finally, Dr. O'Brien was fair to point out that she was time limited in what she could talk about, but that MUCH else was discussed at ASH.

Friends, I hope this helps. As I said, the transcripts will be available at LLS in about a month.

Best,