Over the course of a year of monthly meetings, The CLL Bloodline will teach the BASICS needed to understand CLL, bring news, help with the acronym and new vocabulary, and offer simple, fun quizzes.
MONTHLY QUIZ: CLL (chronic lymphocytic leukemia) and SLL (small lymphocytic lymphoma)
- Are entirely different unrelated cancers.
- Are related but different cancers.
- Are the identical cancers in different parts of the body; SLL in the nodes only, CLL in the blood and maybe the lymph nodes.
- SLL may become CLL.
- 3 and 4 are correct.
ANSWER: The correct answer is #5. To diagnose CLL there must be > 5000 identical or clonal cells per microliter (μl) of blood. In SLL, clonal cells with the same immunophenotyping (genetic fingerprinting), as in CLL are found in at least one lymph node, but there are < 5000 of these cells per μl of blood. SLL becomes CLL if the count exceeds 5000.
As 2022 draws to a close we are asking for your help in supporting our efforts to continue to do everything we possibly can to save the lives of CLL patients. Your generous donations made it possible for us to pivot when COVID-19 struck with new virtual support groups and online education, and advocate for improved therapies for the immunocompromised including better vaccines, and new monoclonal antibodies. You are also supporting our basic science and translational research into the unsolved problems in CLL/SLL. Donations of cash, appreciated stocks, gifts from your IRA or donor advised fund, art, cars, and much more can be transformed into action to benefit our CLL community. The CLL Society is invested in your long life. Please invest in the long life of the CLL Society. You can donate safely through the website. Thank you! Learn more at https://cllsociety.org/donate-to-cll-society/.
EVUSHELD is very likely to be ineffective or less effective against emerging new variants of concern (VOC) of SARS-CoV-2, the virus that causes COVID-19 infections. These VOCs are growing quickly as the agents of new infections. As EVUSHELD is still effective for about half of SARS-CoV-2 in the USA, we still recommend it as of 10/31/2022, but its efficacy is waning fast and we, and the CDC and FDA, might change that recommendation very soon. So, mask up and be safe until the next generation Pre-Exposure Prophylaxis is available. CLL Society is working with several companies on some promising long-term options.
THE BASICS: Types of Treatment
Cellular Therapies are treatments that use cells rather than drugs to treat CLL. The first cellular therapy was a hematopoietic stem cell transplant (HSCT), or a bone marrow transplant. In CLL, this is usually done using a matched donor’s stem cells. It may be curative, but infections and graft versus host (GVHD) disease, where the new immune system attacks the whole patient with skin, eyes, and gut commonly effected, and not just the cancer, makes transplant very high-risk. CAR-T (chimeric antigen receptor – T cells) is experimental in CLL where our own T-lymphocytes are harvested, trained to attack our CLL, grown, and then re-infused. There is no GVHD as it’s the patients’ own cells. Response rates in CLL are high for this “living drug” in those with few remaining options but the durability of the remission is less certain. Neurotoxicity and cytokine release syndrome (CRS), where inflammatory molecules (cytokines) are released causing flu-like symptoms or worse, can occur and rarely be fatal; however, they can almost always be successfully managed. Other cellular therapies include CAR-NK (natural killer) cells and TILs (tumor infiltrating lymphocytes) but they are even less mature in CLL.
WORD/ACRONYM OF THE MONTH: ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANT
Allogeneic stem cell transplant is a procedure in which hematopoietic (blood forming) stem cells are taken from a genetically matched donor (often a sibling or unrelated donor) and given to the patient through an IV. The cells migrate to and hopefully engrafts in the patient’s marrow, providing new stem cells to build all the blood components, and with it, a new immune system that recognizes and attacks the cancer as an invader. This is the desired outcome, called “Graft versus Leukemia (GVL)”. It is still used in CLL, but much less often now due to new therapies including CAR-T that are usually tried first.