Sunday, October 11, 2015

Questions and Answers Provoked by my Blog on CLL (chronic lymphocytic leukemia)

Here are best answers to some questions I recently received. Please email questions as it is difficult to respond this way. Remember I am not a hematologist, pathologist, or transplanter.

1: Please explain if CD 19 is present on both the normal B Cell and cancerous B cell as stated here, then how can CD 5, CD 19, and CD23 be what is used to diagnose CCL per Dr. Weird in a Patient Power interview? Also, are any of the 3 CD’s mentioned above also present in T Cells? on ASH 2012: Dr. Bill Wierda on CAR-T Therapies and "Off the Shelf" T-Cells

ANSWER: CD5 is usually only found on T cells. Its presence on monoclonal B cells is not expected and thus helps diagnose CLL.

Perhaps this chart will help. The information is gained from flow cytometry. Click on it to see a larger version.

2: Hello Dr. Kauffman, I am four years out from a CLL stem cell transplant. I wondering how long ones immune system is compromised after a transplant? Would I still catch pneumonia really easy? on Dr. Byrd Updating the trial data on ibrutinib for CLL (Chronic lymphocytic Leukemia)

ANSWER: Immune recovery post transplant is slow and complicated and varies from patient to patient and even within each patient themselves. Different immune component may recover at different rates. Suffice it to say, one can remain at increased infection and cancer risk for several years after transplant, but after about two years, much of the high risk period is behind you, that is assuming you are no longer on immunosuppressive drugs for graft versus host disease(GVHD) and you are well recovered. For example, routine vaccines are usually begun between 12 and 24 months post allogeneic stem cell transplant, suggesting that your humoral immune system is fairly robust by that time.

Below is some very basic outline of post transplant care.

3: In looking at the ASCO abstract, information is not provided as to the cause of treatment interruption. An interruption due to a drug complication or cll event may have a very different impact on PFS than a break in care for surgery. Is that data available? 

ANSWER: I wish I had that data too. I do understand that many of the patients were quite sick for multiple reasons and that's why they quit. Patients who go off drug for a week or so for a minor surgery as an example should expect better results.

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Blogger Wendy said...

I have no CD5 on my Flow Cytometry for B-Lymphoid, only T/NK cells. Is it possible I was misdiagnosed or could the number just be very low? Perhaps it's just a typo on the report.

October 15, 2015 at 2:02 PM  
Blogger Brian Koffman said...

@Wendy. That is certainly unusual. There are atypical types of CLL. I would recommend you see a CLL specialist for sure to confirm the diagnosis.

October 16, 2015 at 10:21 PM  
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