Wednesday, March 26, 2008

TP53: is it such a big deal?

Everyone knows that p53 abnormalities bode ill for patients with CLL. Generally such leukemias are resistant to fludarabine, cyclophosphamide, chlorambucil, penatastatin, cladribine, and rituximab. Although responsive to high dose steroids and Campath and sometimes to Revlimid, most patients with this abnormality have very short survivals. The data on this come from randomized clinical trials like LRF CLL4. However, not all patients need treatment and these trials lack representation from unreated patients. So I have examined my database for patients with del 17p (the chromosomal abnormality that most commonly causes p53 deletion. Have a look at these graphs:

What they tell us is that patients with mutated IgVH genes who also have del 17p usually don't require treatment, just like other patients with mutated IgVH genes.


Anonymous said...

Good to know! (If you are a mutated patient.)

For those of us unmutated, no good news. Survival appears to be identical whether or not non-CLL deaths are factored out.

Probably CLL kills so fast nothing else is going to get you.

Ironic we've made such strides against heart disease, but it matters not if you have poor prognostic CLL.

I've heard of doctors who advise their patients who smoke, and have CLL, not to give it up. What's the point of denying yourself pleasure when it won't affect your survival at all?

Me, I've gone back to eating red meat frequently, I started having that evening cocktail (or two) again, I don't watch my weight at all, and I am not obsessive about my health in the slightest.

Maybe some good comes from a fatal disease after all!

Anonymous said...

I'm confused about chart number 2. Does everyone suddenly die at the same time, at about 290 months? Otherwise wouldn't the chart not have a solid line at the end?

Terry Hamblin said...

At that time she was teh only person still alive, therefore when she died there was 0% still living. Of course non of teh others had died of CLL, but they have not yet been followed that long. 290 months is more than 24 years, and since teh average age for the diagnosis of CLL is 70, most peopel will have died from natural cases befor they get to be 94.

justme said...

Thanks! This was completely new information for me.