tag:blogger.com,1999:blog-19490962.post2041708403031796890..comments2023-12-10T10:06:41.979+00:00Comments on mutations of mortality: Treatment related MDS/AML in CLLTerry Hamblinhttp://www.blogger.com/profile/06346629921055055879noreply@blogger.comBlogger13125tag:blogger.com,1999:blog-19490962.post-35706250171315782572011-07-19T08:19:53.392+01:002011-07-19T08:19:53.392+01:00Do you think that AML can be caused by a blood tra...Do you think that AML can be caused by a blood transfusion from AML infected blood? That is, could blood with AML that hasn't been diagnosed be mistakenly given to someone who would then get AML?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-19490962.post-39298417968287918522011-01-12T22:06:22.304+00:002011-01-12T22:06:22.304+00:00Thank you very much Professor for your information...Thank you very much Professor for your information. It is very pleasure to know that you are feeling better. Wish you quicker recovery.Jorgehttps://www.blogger.com/profile/11589387374456072979noreply@blogger.comtag:blogger.com,1999:blog-19490962.post-55856859427822846762011-01-12T08:35:52.212+00:002011-01-12T08:35:52.212+00:00Rituxin alone is very poor at treating CLL. The co...Rituxin alone is very poor at treating CLL. The combination has a much higher response rate.Terry Hamblinhttps://www.blogger.com/profile/06346629921055055879noreply@blogger.comtag:blogger.com,1999:blog-19490962.post-25485936778335742572011-01-12T00:05:39.592+00:002011-01-12T00:05:39.592+00:00Prof. Thank for this article.
You said: those w...Prof. Thank for this article. <br />You said: those with mutated IGHV genes might be better served by using chlorambucil and rituxan as first line treatment. <br />My question was: Is chlorambucil and rituxan in combination or, for example ,rituxan only therapy?<br />Thank you so much.Jorgehttps://www.blogger.com/profile/11589387374456072979noreply@blogger.comtag:blogger.com,1999:blog-19490962.post-42197777032411227842011-01-10T08:00:33.548+00:002011-01-10T08:00:33.548+00:00We just don't have enough information about FR...We just don't have enough information about FR. It is probably safer than FCR.Terry Hamblinhttps://www.blogger.com/profile/06346629921055055879noreply@blogger.comtag:blogger.com,1999:blog-19490962.post-18193444487255033712011-01-10T03:59:43.448+00:002011-01-10T03:59:43.448+00:00I am 59 years old, mutated and starting round thre...I am 59 years old, mutated and starting round three of a planned 6 rounds of FR. At this point, my counts are completely normal and I have no more evidence of enlarged nodes. Although I am tolerating the treatment well, I am wondering about the risk/reward ratio associated with completing all six rounds, especially when I read of long term complications such as MDS, AML, or Richter's transformation. <br /><br />My prayers are with you as you fight your own dragon.Kathleen Beattienoreply@blogger.comtag:blogger.com,1999:blog-19490962.post-60308085294654385792011-01-09T08:52:24.674+00:002011-01-09T08:52:24.674+00:00There is a lot of evidence of the carcinogenicity ...There is a lot of evidence of the carcinogenicity of alkylating agents in Hodgkin's disease. It normally occurs 5-10 years after exposure. There is a second category which occurs between 1-5 years after exposure to topoisomerase inhibitors like etoposide and mitoxantrone. This occurs between 1-5 years after exposure. <br />My impression is that MDS/AML in CLL after FC occurs rather earlier than the alkylating agent experience in Hodgkin's disease. <br />The risk seems greatest between 18 months and 3 years and probably persists for 5 years. After that one might see an indolent MDS appear if anything at all. The more doses you receive the greater the risk. A single shot of FCR carries only a very small hazard.Terry Hamblinhttps://www.blogger.com/profile/06346629921055055879noreply@blogger.comtag:blogger.com,1999:blog-19490962.post-51431974915208001202011-01-09T08:41:18.214+00:002011-01-09T08:41:18.214+00:00Terry.
Do you have a sense of the usual time fram...Terry.<br /><br />Do you have a sense of the usual time frame after therapy to develop MDS/AML?<br /><br />Also the doses needed? My only "chemo" was all in one week of FCR as conditioning for my transplant. The F was 30/M2 x 3 days, but the C was 750/M2 x 3 days.<br /><br />Thanks.<br /><br />BrianBrian Koffmanhttps://www.blogger.com/profile/13250684684103918493noreply@blogger.comtag:blogger.com,1999:blog-19490962.post-45303192040859826232011-01-08T22:42:30.350+00:002011-01-08T22:42:30.350+00:00Please do blog! Your wisdom can help us decide whi...Please do blog! Your wisdom can help us decide which treatment risk/benefit profile best fits our particular CLL profile. As there is often no "answer" your input will help make us all better informed medical consumers in the ever evolving world of CLL treatments.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-19490962.post-57152227322786517102011-01-08T08:21:17.880+00:002011-01-08T08:21:17.880+00:00There is certainly a place for FCR and it is the m...There is certainly a place for FCR and it is the most effective treatment for CLL. However, we have to be realistic about what we are trying to do when we treat this disease. For younger patients whose disease is aggressive then aggressive treatment is appropriate. We know that left untreated such patients die very quickly and in these FCR is certainly the best first line treatment, so long as they don't have TP53 problems. But for others we need to be more circumspect and remember that we are treating patients not diseases. I think this is too big a topic to just appear as a comment, and I have decided to blog about it seperately.Terry Hamblinhttps://www.blogger.com/profile/06346629921055055879noreply@blogger.comtag:blogger.com,1999:blog-19490962.post-60425077037003444302011-01-08T04:07:19.055+00:002011-01-08T04:07:19.055+00:00I'm glad you are highlighting the dangers of F...I'm glad you are highlighting the dangers of FCR, a regime you have been touting as the 'gold standard'.<br /><br />As you point out, it is just too risky to use the combination of fludarabine and cyclophosphamide (with or without rituximab), except perhaps as a last-ditch treatment.<br /><br />The fact is that with more modern treatments, there is a definite possibility survival will be extended. <br /><br />It would be a shame to then start losing patients to MDS, AML or Richter's transformation.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-19490962.post-88463896336320258022011-01-07T15:46:20.182+00:002011-01-07T15:46:20.182+00:00Not keen on B which is another alkylating agent. T...Not keen on B which is another alkylating agent. The others might be wise.Terry Hamblinhttps://www.blogger.com/profile/06346629921055055879noreply@blogger.comtag:blogger.com,1999:blog-19490962.post-34000207442724320852011-01-07T15:00:25.590+00:002011-01-07T15:00:25.590+00:00Do you suppose then that patients might be better ...Do you suppose then that patients might be better served by avoiding repeat courses of either FC or FCR when they relapse and instead consider use of BR, R, RR, or newer agents such as CAL-101 or PCI3675.<br /><br />In my case AIHA and PRCA cut short a planned 6 course regimen of FCR at 2 courses which seems to have achieved a reasonably good response for the time being, but more than 6 months since completing the second course of FCR borderline neutopenia with granulocyte "dyspoeisis" persists on the blood smear, which is interesting as the ANC had been good until 3 to 4 months post the last FCR.<br /><br />PS. I do hope that you are feeling better!Anonymousnoreply@blogger.com