tag:blogger.com,1999:blog-19490962.post4453870151276353068..comments2023-12-10T10:06:41.979+00:00Comments on mutations of mortality: Side effectsTerry Hamblinhttp://www.blogger.com/profile/06346629921055055879noreply@blogger.comBlogger4125tag:blogger.com,1999:blog-19490962.post-31690603294655665012009-03-07T12:59:00.000+00:002009-03-07T12:59:00.000+00:00Severe immunodeficincy and del 17p is a difficult ...Severe immunodeficincy and del 17p is a difficult combination since both Campath and steroids tend to make immunodeficiency much worse. An alternative is Revlimid.Terry Hamblinhttps://www.blogger.com/profile/06346629921055055879noreply@blogger.comtag:blogger.com,1999:blog-19490962.post-82864886309491931832009-03-07T11:52:00.000+00:002009-03-07T11:52:00.000+00:00It sounds like Paul and I agree on certain philoso...It sounds like Paul and I agree on certain philosophical approach to treatment.<BR/><BR/>As one with terrible immune from dx and terrible prognostics to include (now) 89% 17p. it has been my opionion that the longer I could go with no treatment, the better.<BR/>After 3 years my WBC went tp 313 and dropping hg and platelets (actually, they were fine on secod hought - but my spleen was uncomfortable and nodes large)<BR/>I have used nothing but 32 mg of RTx weekly and 2 to 4 mg of Chlorambucil, erratically and stopped on RBC/plt destruction and viral activation, easily suppressed with Valtrex.<BR/>I did this for (am doing) for nearly a year with a few breaks in RTX to rebuild complement, rsulting in increase in WBC, though it's really rather stabel and slow growing.<BR/>Now my doc wants to add Cyclo- hmmm. I think its Rtx as long as it works, with occasional transfusions if needed or Procrit, with Campath HDMP as a last resort.<BR/>I wonder, from your writings, wont Camptath be better with no Cyclo or other chemos preceding it?<BR/>And since Prednisone shrinks my nodes in very small doses (5 to 20 mg.s Pred) can I combine those if Campath does not like big nodes? Can i have my spleen removed or is that ill advised?<BR/>I ask these not for myself only, but b/c I truly, truly believe that those with p53 lesions die far too soon for too soon treatment (given poor immune status) and for the wrong treatment -such a Fludara, Treanda, CHOP, et al.<BR/><BR/>Would you share your thoghts, Dr. Hamblin?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-19490962.post-71846940177054746492009-01-21T09:03:00.000+00:002009-01-21T09:03:00.000+00:00Hi Paul,You are right that there has never been a ...Hi Paul,<BR/><BR/>You are right that there has never been a controled trial comparing any treatment with no treatment, but there is no doubt at all that when patients get very ill with CLL and would die untreated within a matter of weeks, it is sometimes possible to rescue them with chemotherapy, and after that they sometimes live for a very long time.<BR/><BR/>It is also true that when patients have severe symptoms from CLL, it is usually possible to relieve them with treatment.<BR/><BR/>What has not been shown in any trial is that using anything other than chlorambucil as first line, extends overall survival. <BR/><BR/>There are studies that show that people are living longer with CLL than they used to, and part of that increased survival may be due to the fact that we have more and possibly more effective drugs now, but there are other explanations: better supportive care; earlier diagnosis; changes in the definition of CLL etc.<BR/><BR/>You are also right to say that all treatments of CLL make the immunodeficiency worse, but whether this is a big issue depends very much on the individual patient. For those who start out with a very poor immune system, it obviously is a very important factor, but for other patients, even a big hit on their immune system leaves them better off than are some patients before they start treatment.<BR/><BR/>That's why treatment is a matter of judgement requiring an experienced physician. You can't do it by applying a formula.Terry Hamblinhttps://www.blogger.com/profile/06346629921055055879noreply@blogger.comtag:blogger.com,1999:blog-19490962.post-45465508065987532142009-01-21T01:33:00.000+00:002009-01-21T01:33:00.000+00:00http://hpgarland.blogspot.com/2009/01/cll-treatmen...http://hpgarland.blogspot.com/2009/01/cll-treatments.htmlH Paul Garlandhttps://www.blogger.com/profile/18095099328378334859noreply@blogger.com