MONTHLY QUIZ: B lymphocytes that cause CLL can proliferate in all the following areas of the body except:
- The lymph nodes
- The bloodstream
- The bone marrow
- The spleen
ANSWER: The correct answer is # 2. CLL is a cancer of the B cells. Therefore, it is both a leukemia and lymphoma. The cancer cells accumulate in the blood, making it leukemia with high lymphocyte counts. However, they only proliferate or reproduce in the nodes, bone marrow, and the spleen. They cannot reproduce in the blood.
- A big win: The NIH updated guidance released on 8/8/22, COVID-19 Treatment Guidelines: Special Considerations in People Who Are Immunocompromised, now includes:
“…This section pertains to people who are moderately or severely immunocompromised, which includes those who: …
- Have hematologic malignancies (e.g., chronic lymphocytic lymphoma, non-Hodgkin lymphoma, plasma cell dyscrasias) and are known to have poor responses to COVID-19 vaccines or an increased risk of severe COVID-19, regardless of the treatment status for the hematologic malignancy.”
This resulted from over a year’s work and is almost word for word what we asked to be done. Thanks to all who supported and helped CLL Society to make this happen. This should make it easier to access Evusheld and other therapies for COVID and possibly other infections where we are at higher risk.
- CLL Society announced the winner of CLL Society’s First Ever Young Investigator Research Program Award: Dr. Christine Ryan, on the topic of Richter’s Syndrome studying BH3 genetic profiling. Thanks to all whose donation supports our research grants.
- Please help us by submitting a comment to the FDA to help keep the PI3K inhibitor duvelisib (Copikra) available as a treatment option. Your voice will make a difference. We strongly believe we need more, not fewer, treatment choices. Details on how to submit can be found here. THE DEADLINE IS SEPTEMBER 8.
BASICS: Types of CLL Treatment – This month, we begin describing broad therapy categories.
Chemo-immunotherapy (CIT) used to be the primary treatment for CLL. Today, depending on which CLL expert you consult, there would be no role or a very limited role for only a few frontline patients. Sadly, it is being used often in the community. It consists of chemo drugs that damage the cell’s DNA and non-specifically kill anything that grows quickly, such as cancer cells, skin, hair, gut, and normal blood cells. In CLL, common drugs are fludarabine (F), cyclophosphamide (C), bendamustine (B), and chlorambucil. Chemo is more effective when combined with immunotherapy (IT). Usually, a monoclonal antibody (mAb): rituximab (R) or obinutuzumab (Gazyva) that targets a specific marker (CD20) found only on CLL and normal B cells. Common CITs are FCR, BR and chlorambucil, and obinutuzumab. There is NO role for chemotherapy alone to treat CLL, though that too is still used by some hematologists. Studies proved that ibrutinib is superior to both FCR and BR, making the role of CIT even more limited.
WORD/ACRONYM OF THE MONTH: CD
CD or Clusters of Differentiation are proteins on the cell surface used by flow cytometry (cellular fingerprinting) to diagnose CLL or look for measurable (minimal) residual disease. They are also a target for monoclonal antibodies and CAR-T to attack, such as how rituximab seeks CD20 or CAR-Ts seek CD19.
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