FCR? I think HDMP+R is a better option

[Guest guest]

The problem with doing FCR first is that EVERYONE relapses from FCR, then you

are fludarabine refractory, and your median survival as a refractory patient is

9 months.

Also, there is a greater risk of secondary malignancies with fludarabine, as

well as a greater chance of Richter's transformation.

Eventually, fludarabine will never be used in CLL. It's only used now because

it has a nice palliative effect and give some people a remission. However, it

damages the bone marrow and it can lead to major, major problems down the road.

I think a much better choice for your first treatment is HDMP+R. Patients have

been getting molecular remissions from the regime, and, if combined with a

Campath 'chaser', it has been shown to lead to the reconstitution of the immune

system, something that has not been seen before in CLL, except in the realm of

the stem cell transplant.

Using high-dose methylprednisolone and rituxan at an experienced cancer center

such as UC San Diego doesn't burn any bridges and allows you to use the

fludarabine poison sometime down the road if you need it.

Reverse the order of treatment, and you will have a much worse time of it.

HDMP+R is immunosuppresive, and campath is very immunosuppressive, so I'd only

have it done at a CLL center by a CLL expert. Even there, one needs to be on

prophylaxsis using antibiotics, anti-virals, and antifungal drugs. One needs

to be careful, but one may have a very, very long remission.

I know personally of one person who did the regime, and she doesn't have any

evidence of her CLL, and has a normal immune system. Is she cured? Who knows,

but she said she has moved beyond CLL and views it as a three-year long ordeal

she doesn't have to worry about any longer.

How about that for a goal?

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Regarding your husband, it is important to remember that eventhough the WBC is

rising, there may be no indication for treatment. Treatment options could

include fludarabine based chemotherapy, alemtuzumab, bendamustine, or clinical

trial. I would not let the shingles factor in because Valtrex should be able to

prevent any re-emergence on therapy.