Wednesday, May 16, 2012

Alemtuzumab in Combination With Methylprednisolone for 17p deleted patients

J Clin Oncol. 2012 May 10;30(14):1647-55. Epub 2012 Apr 9.

Alemtuzumab in Combination With Methylprednisolone Is a Highly Effective Induction Regimen for Patients With Chronic Lymphocytic Leukemia and Deletion of TP53: Final Results of the National Cancer Research Institute CLL206 Trial.

This article (link hereis notable for three things.

First, it offers a very impressive response rate in the most difficult to treat patients. 85% overall with 36% CR (complete remission).  7 of10 patients with lymph nodes > 5 cm responded and two had CRs. Wow!

Second, it has a very high risk of serious infections. I quote:

"Grade 3 to 4 infection occurred in 51% of the overall cohort and in 29% of patients less than 60 years of age. Treatment-related mortality was 5%"

Still it is an options for those with 17p del who have so few options and a trial with tyrosine kinase inhibitor is not in the cards. It makes most sense in younger patients, younger being less than 60. It could be a bridge to transplant as median progression free survival was about a year, time enough to get the transplant team rolling and get the Campath out of your system.

Overall, however, it is a risky path as both HDMP(Methylprednisolone) and alemtuzumab (Campath) are very immunosuppressive. It is not just the risk of catching some bug. It is the risk of waking up something you already caught and that has been dormant for years such as zoster or CMV. The steroids have other significant side effects too and surprising  two out of three patients had grade 3 or 4 hematologic toxicities.

I might opt for HDMP+O myself if I wasn't in this ibrutinib + O trial here at OSU, but the data on HDMP + A is very persuasive and would need to be carefully considered.

Third and final point, one of the authors is the late great and much beloved Terry Hamblin. While admittedly, some of this is old data presented in 2009, it is updated for this 2012 publication months after his passing. 

Truly Dr. Hamblin lives on in the work he has done and so much more.

What a blessing his life was for those of us who knew him.

On personal note, I am continuing to do well in Columbus with my three grey pills of ibrutinib every morning. Looking forward to a few weeks of no infusions. I have less gut issues, more muscle pains, and smaller nodes. Life is good.

If the weather is good tomorrow I am going canoeing in Darby Creek. Dinner with new friends. Tonight went for a sunset walk in Prairie Oaks, a beautiful Metro Park. The Kings (HOW BOUT THOSE KINGS?) are on TV here.

I really like Columbus.

I am also really glad I will be home to stay in a few weeks. 

I have Stanley Cup playoff tickets that are finally useful and I have to sell them all. It probably will all be over just a few days before I get home. Maybe I can still catch the victory parade.


PS. I love this kind of post: Raw science, good news, dear friends, nature, and hockey in one sweep!

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