Re: Question for Dr. Furman II

[Guest guest]

Fred,

The risk of neuropathy from the vincristine is quite real. As long

you are followed closely for the development of any symptoms of

neuropathy, it should be possible to avoid significant problems.

Most people will develop some numbness with vincristine. This should

improve with time, but ofter after a long time. Many physicians

prescribe vitamin B6 to help lessen the neuropathy, but there are no

data that it helps.

One aspect to note is the use of R-CVP post chlorambucil. The CVP

might work given that it is an alkylator being used on a different

schedule than the chlorambucil (also an alkylator). Another option

is to try FCR depending upon the duration of your response to

fludarabine. If your response to fludarabine was poor, then the best

option would be the Humax-CD20 or Revlimid clinical trials.

Rick Furman, MD

>

> ,

>

> I hope this gets through. A few hours ago I tried to reply to your

notice about Dr Furman by posting a message using " REPLY (via web

post) " . In the subject line I listed the problem I'm having along

with Dr Furman's name , hit Send and never saw it again. Having

problems with is nothing new with me. BTW, I was asked to log

in, which I did, but here I sit. Anyway, I'll try again by simply

Replying to your message via OE.

>

> My problem, and question, stems from my large lymph nodes for which

my local hem/onc has prescribed R-CVP. I'm concerned about the

potential for neuropathy from use of Vincristine and would like to

know if there is anything one can do to reduce that potential and

whether there are any early warning signs for developing neuropathy.

>

> Fred Hummel, 80, Arcata, CA;

> CLL/SLL dx 1.98;

> Fludara 2000;

> Fludara, Rituxan, Novantrone, Decadron, 2002;

> Rituxan, 2004;

> Rituxan, Chlorambucil, Prednisone, 2005;

> Rituxan, Chlorambucil, Prednisone, 2006;

> IVIg monthly 12/06 - 5/07.

>

>

> Dr. Furman

>

>

>

> Folks - Dr. Furman is now officially on our group, as our medical

adviser.

>

> He can be contacted via the group, like they do with Dr. Hamblin

on the ACOR list.

>

> Unless necessary, I ask that you not contact him directly, but

post your questions on the group, so that we can all benefit from the

question and his answer.

>

>

>

>

>

>

>

> --------------------------------------------------------------------

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> See what's free at AOL.com.

>

[Guest guest]

As an aside, for those who are not responding to fludarabine, the

best looking agents right now are Humax-CD20 or Revlimid. Both of

these agenets seem to be effective and well tolerated.

Dr Furman

>

> Fred,

> Have you looked at Dr. Kipps stuff: High Dose Methylprednisolone +

Rituxan?

> Good Health and good luck,

> Dan Hill

> Re: Re: Question for Dr. Furman II

>

>

>

> Thank you, Dr Furman, for your advice. Armed with that I was able

to extend the discussion of TX with my hem/onc and he, after doing

some research of his own, has offered a different treatment, one that

does not include vincristine.

>

> I will be doing what he calls FC Lite. Reduced amounts of Fludara

and Cytoxan for four, or possibly 6, cycles. I've done reasonably

well with F before with only 3 cycles each time; C will be a new drug

for me.

>

> I'm looking forward to getting some relief from these problematic

nodes which have never been more than a cosmetic issue before.

>

> Thanks, again, for your help and for all those patients who have

contacted me.

>

> Fred Hummel, 80, Arcata, CA;

> CLL/SLL dx 1.98;

> Fludara 2000;

> Fludara, Rituxan, Novantrone, Decadron, 2002;

> Rituxan, 2004;

> Rituxan, Chlorambucil, Prednisone, 2005;

> Rituxan, Chlorambucil, Prednisone, 2006;

> IVIg monthly 12/06 - 5/07.

>