Summary

The treatment of CLL is evolving as investigators test new treatments and new combinations. The optimal approach has yet to be defined. In Figure 1, the approach taken by the group at the Cleveland Clinic Taussig Cancer Center is outlined. Treatment is delayed until the onset of symptomatic progression, at which time the most effective therapy, FCR, is administered in the hope that a higher CR rate will translate into longer remission and improved overall survival. Post-remission treatment is investigational. Treatment with FCR is continued until the patient becomes FLU refractory. If no clinical trial is available, alemtuzumab is given.

The approach outlined in Figure 26.1 largely assumes that all patients have the same disease. As discussed in Chapter 25, this assumption is false. Unfortunately, we are currently unable to offer patients with adverse risk factors, such as ZAP-70 expression, treatment options that are known to improve their prognosis. Risk-adapted approaches to CLL are as desperately needed as are new drugs and methods, which advocate for accrual to innovative clinical trials.

leukemia: results from Cancer and Leukemia Group B 9712 (CALGB 9712). Blood 101(1):6-14, 2003.

8. Keating MJ, O'Brien S, Albitar M, et al.: Early results of a chemoimmunotherapy regimen of fludarabine, cyclophosphamide, and rituximab as initial therapy for chronic lymphocytic leukemia. J Clin Oncol 23(18):4079-4088, 2005.

9. Rawstron AC, Kennedy B, Evans PA, et al.: Quantitation of minimal disease levels in chronic lymphocytic leukemia using a sensitive flow cytometric assay improves the prediction of outcome and can be used to optimize therapy. Blood 98(1):29-35, 2001.

10. Montillo M, Tedeschi A, Miqueleiz S, et al.: Alemtuzumab as consolidation after a response to flu-darabine is effective in purging residual disease in patients with chronic lymphocytic leukemia. J Clin Oncol 24(15):2337-2342, 2006.

11. Moreton P, Kennedy B, Lucas G, et al.: Eradication of minimal residual disease in B-cell chronic lymphocytic leukemia after alemtuzumab therapy is associated with prolonged survival. J Clin Oncol 23(13):2971-2979, 2005.

12. Wendtner CM, Ritgen M, Schweighofer CD, et al.: Consolidation with alemtuzumab in patients with chronic lymphocytic leukemia (CLL) in first remission—experience on safety and efficacy within a randomized multicenter phase III trial of the German CLL Study Group (GCLLSG). Leukemia 18(6):1093-1101, 2004.

13. Huhn D, von Schilling C, Wilhelm M, et al.: Rituximab therapy of patients with B-cell chronic lymphocytic leukemia. Blood 98(5):1326-1331, 2001.

14. O'Brien SM, Kantarjian H, Thomas DA, et al.: Rituximab dose-escalation trial in chronic lymphocytic leukemia.

J Clin Oncol 19(8):2165-2170, 2001.

15. Byrd JC, Murphy T, Howard RS, et al.: Rituximab using a thrice weekly dosing schedule in B-cell chronic lympho-cytic leukemia and small lymphocytic lymphoma demonstrates clinical activity and acceptable toxicity.

J Clin Oncol 19(8):2153-2164, 2001.

16. Fiegl M, Falkner A, Hopfinger G, et al.: Routine clinical use of alemtuzumab in patients with heavily pretreated B-cell chronic lymphocytic leukemia: a nation-wide retrospective study in Austria. Cancer 107(10):2408-2416, 2006.

17. Keating MJ, Flinn I, Jain V, et al.: Therapeutic role of alemtuzumab (Campath-1H) in patients who have failed fludarabine: results of a large international study. Blood 99(10):3554-3561, 2002.

18. Knauf W, Rieger K, Blau W, et al.: Remission induction using alemtuzumab can permit chemotherapy-refractory chronic lymphocytic leukemia (CLL) patients to undergo allogeneic stem cell transplantation. Leuk Lymphoma 45(12):2455-2458, 2004.

19. McCune SL, Gockerman JP, Moore JO, et al.: Alemtuzumab in relapsed or refractory chronic lympho-cytic leukemia and prolymphocytic leukemia. Leuk Lymphoma 43(5):1007-1011, 2002.

20. Osterborg A, Dyer MJ, Bunjes D, et al.: Phase II multicenter study of human CD52 antibody in previously treated chronic lymphocytic leukemia. European Study Group of CAMPATH-1H Treatment in Chronic Lymphocytic Leukemia. J Clin Oncol 15(4):1567-1574, 1997.

21. Lozanski G, Heerema NA, Flinn IW, et al.: Alemtuzumab is an effective therapy for chronic lymphocytic leukemia with p53 mutations and deletions. Blood 103(9): 3278-3281, 2004.

22. Bowen AL, Zomas A, Emmett E, Matutes E, Dyer MJ, Catovsky D: Subcutaneous CAMPATH-1H in fludarabine-resistant/relapsed chronic lymphocytic and B-prolym-phocytic leukaemia. Br J Haematol 96(3):617-619, 1997.

23. Cortelezzi A, Pasquini MC, Sarina B, et al.: A pilot study of low-dose subcutaneous alemtuzumab therapy for patients with hemotherapy-refractory chronic lympho-cytic leukemia. Haematologica 90(3):410-412, 2005.

24. Martin SI, Marty FM, Fiumara K, Treon SP, Gribben JG, Baden LR: Infectious complications associated with alemtuzumab use for lymphoproliferative disorders. Clin Infect Dis 43(1):16-24, 2006.

25. O'Brien SM, Keating MJ, Mocarski ES: Updated guidelines on the management of cytomegalovirus reactivation in patients with chronic lymphocytic leukemia treated with alemtuzumab. Clin Lymphoma Myeloma 7(2):125-130, 2006.

26. Laurenti L, Piccioni P, Cattani P, et al.: Cytomegalovirus reactivation during alemtuzumab therapy for chronic lymphocytic leukemia: incidence and treatment with oral ganciclovir. Haematologica 89(10):1248-1252, 2004.

27. Nguyen DD, Cao TM, Dugan K, Starcher SA, Fechter RL, Coutre SE: Cytomegalovirus viremia during Campath-1H therapy for relapsed and refractory chronic lympho-cytic leukemia and prolymphocytic leukemia. Clin Lymphoma 3(2):105-110, 2002.

28. Wierda W, O'brien S, Faderl S, et al.: A retrospective comparison of three sequential groups of patients with Recurrent/Refractory chronic lymphocytic leukemia treated with fludarabine-based regimens. Cancer 106(2):337-345, 2006.

29. Wierda W, O'Brien S, Wen S, et al.: Chemoimmunotherapy with fludarabine, cyclophosphamide, and rituximab for relapsed and refractory chronic lymphocytic leukemia.

J Clin Oncol 23(18):4070-4078, 2005.

30. Lamanna N, Kalaycio M, Maslak P, et al.: Pentostatin, cyclophosphamide, and rituximab is an active, well-tolerated regimen for patients with previously treated chronic lymphocytic leukemia. J Clin Oncol 24(10):1575-1581, 2006.

31. Byrd JC, Lin TS, Dalton JT, et al.: Flavopiridol administered using a pharmacologically derived schedule is associated with marked clinical efficacy in refractory, genetically high-risk chronic lymphocytic leukemia. Blood 109(2): 399-404, 2007.

32. Chanan-Khan A, Miller KC, Musial L, et al.: Clinical efficacy of lenalidomide in patients with relapsed or refractory chronic lymphocytic leukemia: results of a phase II study. J Clin Oncol 24(34):5343-5349, 2006.

33. O'Brien SM, Cunningham CC, Golenkov AK, Turkina AG, Novick SC, Rai KR: Phase I to II multicenter study of oblimersen sodium, a Bcl-2 antisense oligonucleotide, in patients with advanced chronic lymphocytic leukemia.

J Clin Oncol 23(30):7697-7702, 2005.

34. Kath R, Blumenstengel K, Fricke HJ, Hoffken K: Bendamustine monotherapy in advanced and refractory chronic lymphocytic leukemia. J Cancer Res Clin Oncol 127(1):48-54, 2001.

35. Bergmann MA, Goebeler ME, Herold M, et al.: Efficacy of bendamustine in patients with relapsed or refractory chronic lymphocytic leukemia: results of a phase I/II study of the German CLL Study Group. Haematologica 90(10):1357-1364, 2005.

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Chapter 27

10 Ways To Fight Off Cancer

10 Ways To Fight Off Cancer

Learning About 10 Ways Fight Off Cancer Can Have Amazing Benefits For Your Life The Best Tips On How To Keep This Killer At Bay Discovering that you or a loved one has cancer can be utterly terrifying. All the same, once you comprehend the causes of cancer and learn how to reverse those causes, you or your loved one may have more than a fighting chance of beating out cancer.

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