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This study looked at the effect of interruptions to daily ibrutinib (Imbruvica) treatment in patients with chronic lymphocytic leukemia. This study concluded that interruptions can have negative effects on patient outcomes. Chronic lymphocytic leukemia (CLL) is a cancer that affects the lymphocytes (a type of white blood cell). Ibrutinib is a common treatment for CLL combined with chemotherapy. Ibrutinib is a Bruton’s tyrosine kinase inhibitor. This treatment blocks the effects of a protein involved in cancer cell growth. Some patients may need to take breaks from treatment due to side effects. The effects of ibrutinib wear off quickly when treatment is stopped. Cancer cells begin growing again. However, the effects of treatment interruptions on outcome are not known.  This study involved 195 patients with CLL or a similar form of lymphoma (SLL). All patients were treated with ibrutinib once daily by mouth over a 9 month period. Patients were followed for up to an average of 30.4 months. Those taking a higher dose (420 mg) of ibrutinib had longer progression-free survival (time from treatment until disease progression) than those taking a lower dose (140-280 mg). This was not affected by whether patients had certain genetic changes (del17p and TP53) or not. Patient weight or age also did not interfere with treatment. Patients treated with a higher dose had a 94% 12-month overall survival rate (time from treatment until death from any cause). This was compared to 75% for those treated with a lower dose. 79 patients needed to stop treatment due to adverse events. Treatment was stopped for an average of 18.7 days (range 8-56 days). The effectiveness of treatment was significantly reduced when patients missed more than 8 days in a row. Progression-free survival was significantly lower in those missing more than 8 days in a row. 

This article reviewed what is known about familial chronic lymphocytic leukemia (fCLL). Chronic lymphocytic leukemia (CLL) can be described as two types. In sporadic CLL (sCLL), patients do not have a family history of CLL. In fCLL, patients will have at least one blood relative (such as a sibling or cousin) diagnosed with CLL. A family history of CLL may also increase the risk of other blood cancers. fCLL occurs in roughly 5% to 10% of all patients wtih CLL. The current review discusses the definition and features of fCLL. A family member with CLL increases the risk of developing CLL 2.5- to 7.5-fold. There is also a 45% increased risk of developing non-Hodgkin lymphoma, and a 2.35-fold increase risk of developing Hodgkin lymphoma. Staging and prognosis for patients with fCLL are determined in the same way as sCLL. Females tend to develop fCLL more often than males. Females with fCLL are also more likely to develop second tumors than females with sCLL. FCLL tends to occur at ages roughly 10 years younger than sCLL. The rate of higher disease stage (severity) is similar between fCLL and sCLL. No significant differences in survival have been noted between the two.  Response to treatment is also similar. Genetic mutations (permanent changes) are important factors in predicting prognosis. These mutations cause the overexpression (increased presence) of certain proteins and substances. These mutations are generally reported to be similar in fCLL and sCLL. Further studies are needed to evaluate genetic differences between fCLL and sCLL.