Re: Fwd: Question About Cycles

[Guest guest]

The data generated for most clinical trials was done using six cycles of

therapy. Using fewer cycles may or may not compromise the effectiveness of the

chemotherapy. We just do not know. In theory, hitting the CLL cells when they

have already been damaged with more chemotherapy (i.e. the next cycle) will help

make sure the die and do not repair themselves. As most of you have heard me

say, I believe in doing what has been demonstrated as beneficial by trials.

The theoretical risk of early relapse and needing additional therapy would be a

big negative to stopping treatment early.

I am concerned about the damaged caused by chemotherapy, but this is why we are

using lenalidomide plus rituximab in untreated patients and CAL-101, etc. These

non-chemotherapy agents offer a means of controlling the CLL without

chemotherapy and associated toxicities.

Rick Furman, MD

>

> Hi CLL friends,

>

> I wonder about the same issue. technically I am still in watch and worry

> but i did have my tonsils out 18 months ago due to the large nodes that were

> in my throat. I was snoring terribly with sleep apnea as well. I had lost

> weight and was on the verge of needing my first treatment for CLL.

> I was given a healthy dose of steroids for the inflammation at the time

> of my tonsillectomy and guess what happened to my CLL? I felt great after.

> White cell count went down to 94 from 154. That was 18 months ago.

> So now as I consider future tx, Why not just consider one or two doses of

> R and a steroid instead of 6 cycles? I know there's a trend towards minimal

> residual disease and it does make sense except for the damage long term.

> Could it be that the smartest choice in some cases would be an approach

> towards long term control rather than complete war with our invincible CLL?

> I wonder even how many practitioners would even consider this approach due

> to insufficient clinical trials supporting such. being 50 with hope of many

> years to come, I really hope to consistently choose the smallest yet

> effective hammer possible for my CLL. Cutting down the cycles in some cases

> seems a smart way to go when ever possible.

> wondering how much research has shown in this regard.

> sincerely,

> Leo

>

>

>

> ____________________________________

> From: fch@...

> Reply-to:

>

> Sent: 2/5/2010 2:46:28 P.M. Pacific Standard Time

> Subj: Re: Question About Cycles

>

>

>

>

>

> Jim,

>

> My short response is that if your blood work warrants it, discontinue. I

> have no idea of your age or disease history but I am 83 and heavily

> pretreated. I started B at 70 mg/m2 and R at the usual rate and my platelets

> tanked immediately. After a 2-month hiatus we resumed the B at 55mg/m2 along

> with the R and WBC dove to 1.0, neuts to 0.3. Three months later WBC is up a

> bit but neuts still at 0.7.

>

> Nodes did start to show shrinkage but are increasing in size again. My

> hem/onc thinks B is just to toxic for me and we are considering Arzerra.

> Interesting that the makers of B recommend dosage of 100mg/m2 despite a

European

> trial that calls for 70mg/m2 as the optimal maximum dose. You can find the

> abstract of the findings on CLL Topics. In essence, B worked for me, but

> too well.

>

> Fred Hummel, 83, Arcata CA, DX 1/98

> Fludara 2000;

> Fludara, Rituxan, Novantrone & Decadron 2002;

> Rituxan 2004; Rituxan & Leukeran 2005, 2006;

> IVIG 2007; RFC Lite 2007. Started R & B 2009.

>

>

> In the 10 years that I have received chemotherapy for CLL, the treatments

> (F, R and currently bendamustine HCl) have suggested " up to 6 cycles. " I

> have normally received four cycles, never six that I can recall. Last month,

> I started on bendamustine therapy (100 mg/M2) on days 1 and 2 of a 28-day

> cycle. Although I just finished my second cycle yesterday, the adenopathy

> that had built up in my neck has almost entirely cleared out after my first

> cycle last month. My chest and abdomen were free from enlarged nodes prior

> to treatment. The nausea and chills from bendamustine aren't pleasant, but

> I'm more concerned about myelosuppression and other more debilitating side

> effects. Based on my condition at this time, and that bendamustine is

> potentially more toxic than my prior therapies, I am wondering if it would be

> reasonable to discontinue the bendamustine after two cycles, as long as my

> blood work warrants it. Also, is there any data available that suggests re!

> ceiving fewer cycles of an agent can prolong the period of time that it will

> be effective for a patient (before becoming refractory to it)?

>

>

>

> ____________________________________

>