Friday, July 6, 2012
Chronic Lymphocytic Leukemia – not much going on.
The other day I came across a little review of the treatment of chronic lymphocytic leukemia. This is not a terribly common disease. Only about 16,000 people are diagnosed in the U.S. each year. But, I saw a large number of people with this disease in my practice. The reason for this is that this is not a very deadly disease; patients tended to linger in my practice for a long time. In fact, since this is generally a disease of older people, with 70 percent being over 65, other diseases would often take them away before the leukemia could. Although for the most part it is incurable, many people with CLL live 20 or more years without needing therapy. But there is another group that has a more aggressive disease and should get treatment soon after they are diagnosed. When I was in practice we didn’t have any very effective drugs. We had drugs that could eliminate most of the leukemia cells, but never cure the disease. Eventually, the leukemia would come back in spite of continuing treatment. So when I saw this article, I assumed that there were new treatments and drugs to offer these patients, because I had seen preliminary reports suggesting breakthroughs. Wrong! Yes many new drugs have been developed, but none are particularly effective. The only one that seems to be useful is a drug called Rituximab, which is an antibody directed against a molecule on the CLL surface. But even this drug saved only a few more people when it was added to standard treatment, treatment that is not much different than what I used. And in the key study where this was discovered, most of the patients were much younger than average. The only breakthrough that has occurred in the last few years, is that we have new molecular techniques that are able to identify those patients whose disease would rapidly progress. And this is important, especially for younger patients since the newer treatment does help a few of them. And if they are really young, they might even be helped by very aggressive chemotherapy and a bone marrow transplant. But for most patients, who are older and have active disease, a disappointment! No breakthroughs like the one for people with chronic myelocytic leukemia (see my article on Kareem and CML) where we have found drugs that are life-saving. Sorry.