Re: Re: Fludarabine causes AHA in husband ..Dr. Hamblin?

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No. Treatment for CLL becomes a problem though.

In a message dated 09/10/2010 02:20:50 GMT Daylight Time, lindaterra@... writes:

Dr. Hamblin, thank you so much for taking the time to respond to my post. I will definitely take this up with our local hemotologist/oncologist and will set a new appointment in Ohio with Dr. Byrd. Another question. Once the AIHA is under control (I have now read the paper by Dr. Rai) what does this mean for treating the actual CLL? Hubby has only had one round. He is unmutated and uses the VH3-48 gene. The treatment for the AIHA doesn't help keep him in remission does it? >> > > I was the one who first discovered that fludarabine caused hemolytic > anemia. It is possible that when your husband recovers almost any treatment will > retrigger another episode. In my opinion the best remedy is the Kanti Rai > regimen that involves steroids, cyclophosphamide and rituximab. He might > also find that cyclosporin is helpful. It is very unusual for FCR as opposed > to fludarabine alone to cause AIHA; in the recent German trial it was less > than 1% of cases. > > Bendamustine is almost certainly contraindicated unless it is given with > cyclosporin cover. DR Byrd is an expert on fludarabin-induced AIHA and he > should be able to advise you.> > Terry Hamblin MD> > > In a message dated 08/10/2010 00:59:05 GMT Daylight Time, > lindaterra@... writes:> > > > > Hi, I'm new here. This is my first post actually. We are from land. > Hubby was diagnosed in May '08. He's being treated by a > Oncologist/hemotologist at U of Penn Hospital in Philadelphia. He also sees Dr. Byrd at OSU > every few months. > > The reason I'm here is I need some techinical help. My husband is in a > study Dr. Byrd suggested to him and set him up to see the doctor at Penn who > is participating. It's only running there and at MD . T cells are > removed prior to FCR and at the end of FCR rounds the manipulated T cells are > given back hoping they will now know how to kill any new cancer cells that > start to return. He just finished his first round of FCR. A week later he > is in the hospital due to the Fludarabine causing severe anemia. Tested and > found to be Coombs positive. His rbc are in the basement. He's been in the > hospital for 5 days now. He's had 6 units of blood and is on steroids. He > is showing signs of improvement at this point with his hgb bouncing around > between 7.8 and 8.5. A real improvement. Looks like he'll be there for a > couple more days.> > The doctor says Fladarabine is out of the question now. He has stated he > will be using Bendamustine instead. But... and here's where I need the help. > I've been reading papers that suggest Bendamustine also causes auto immune > problems just like Fladarabine if you're coombs positive. > > Anyone have information on this for me? Or experience? > I hear this reaction to fludarabine only happens in 5% of cases. Not very > lucky are we? And ofcourse this will probably make them toss my husband > from the study > > >