Vital Information, folks!

[Guest guest]

Marcia and others:

As one who's had 13 rds of fludarabine, I'm interested in any and all

connections between fludarabine & Richter's Transformation, as

discussed on Venkat's website and Elsevier articles,

(which can't be accessed unless you're a member and being a member

means you must give your credit card infor and be charged whatever they

decide for articles), The claim is made that 12% of all

fludarabine-treated patients will develop R. T. and half will get it

within 4 mos of tx. But a Feb. 2009 article on a site called UpToDate,

written at " Physician-Level " by 2 Harvard Medical School doctors and an

editor of " Hematology " entitled " Pathology and Treatment of Richter's

Transformation " states the following: " Although immunosuppression

related to treatment with fludarabine has been suggested to promote RT,

several studies have found that purine analogue therapy is not a risk

factor [5,12,13]. " The article goes on to cite a significant study

done at MD :

" In a review of the MD experience between 1975 and 2005, RT

occurred in 148 of 3,986 patients with CLL (3.7 percent) [15]. In an

earlier report of their experience, clinical features associated with

RT included [5]: "

* Elevated serum lactate dehydrogenase — 82 percent

* Progressive lymphadenopathy — 64 percent

* Systemic symptoms — 59 percent

* Monoclonal gammopathy — 44 percent

* Extranodal involvement — 41 percent "

The same article also states: " The incidence of RT from CLL/SLL to

diffuse large B cell lymphoma has been variously estimated at 2 to 9

percent [1,4-7], making it less common than histologic transformation

of other low-grade mature B cell malignancies (show histology 1). The

median time from the diagnosis of CLL/SLL to transformation has been in

the range of two to four years [4,5,8]. "