cll lymphoma | Processing of the LLC

Processing of the LLC


Treatment options for chronic lymphoid leukemia (LLC)
Although it is not yet possible to cure the LLC, it is possible to feel well for years with this disease. Treatment options are based on many factors, including determining the stage of cancer, the presence of symptoms such as fever, weight loss, or how the patient responds to treatment. Patients can stay under surveillance for many years without the need for treatment. In contrast, patients with advanced disease symptoms receive almost all treatment.

The main purpose of the LLC treatment is to:

Slow the accumulation of chronic lymphocytic leukemia cells;
Keep patients in a state of health sufficient to allow them to perform their daily activities
Maintain the patient's quality of life
Improve the number of normal blood cells (white cells, red cells and platelets).


The LLC's standard processing options include:

Vigilance (monitoring and waiting)
Chemotherapy:
Biological therapy
Stem cell transplant
Radiation therapy
The splenectomy


Vigilance (also known as surveillance and waiting)
Vigilance is a strategy whereby health care professionals closely monitor the condition of patients, without setting up treatment, as long as symptoms do not appear or change. This period is also called monitoring and waiting or observation.

During the period of vigilance, you must meet your oncologist for follow-up visits to verify that there are no significant changes in your health condition.

The reason why vigilance is used as an approach is that no study has shown that the introduction of immediate treatment prolongs life. And since the treatment affects both healthy and cancerous cells, the experts recommend for the moment to delay treatment until it is necessary. Some people will never need treatment.

Chemotherapy:
Patients with chronic lymphoid leukemia may undergo chemotherapy as a monotherapy. Examples:

Chlorambucil can be administered orally with some immediate side effects.
Fludarabine is administered orally or intravenously and may cause some side effects.
Many patients with an LLC will follow chemotherapy used for the treatment of other lymphomas:

FC chemotherapy (Fludarabine and cyclophosphamide)
CVP chemotherapy (cyclophosphamide, vincristine and prednisone)
CHOP chemotherapy (cyclophosphamide, doxorubicin, vincristine and prednisone).

Patients should be aware of all treatment options available to them and discuss with their physicians the option that suits them best.

Biological therapy

Biological therapy is a treatment that stimulates or restores your immune system's ability to fight diseases or infections.

Rituximab (RituxanMD) and alemtuzumab (CampathMD) are examples of monoclonal antibodies that can be used alone or in combination as part of chemotherapy.

Stem cell transplant

Patients suffering from chronic lymphocytic leukemia may be candidates for a stem cell transplant. In a stem cell transplant, immature blood cells (stem cells) are taken from the patient's blood or bone marrow (autologous transplantation) or from a compatible donor (transplantation allogeneic). Stem cell transplant is an aggressive treatment still considered experimental. However, it can be an option for young patients with an LLC and no longer responding to treatment.

Radiation therapy

Radiation therapy can be used to:

Reduce the size of a enlarged spleen (very rare case);

Reduce the size of a particular lymph node.

The splenectomy

The removal surgery of a enlarged spleen is seldom necessary, but can be performed for:

Relieve the pressure induced by a enlarged spleen on the other organs;

Stop the accelerated destruction of red blood cells and platelets.

Some factors influencing the decision to treat LLC patients *

Relatively rapid increase in the number of lymphocytes in the blood

hypertrophied lymph nodes

Enlarged Rate

Anemia is getting worse

Drop in the number of platelets

* Many of these factors are often present at the same time.

Chemotherapy:

Patients with moderate or high risk of illness are generally treated with chemotherapy and/or monoclonal antibody therapy. The choice of the recommended treatment usually depends on the general health of the patient and the stage of his illness. Age can play a role in certain types of treatments.

Fludarabine (FludaraMD) is considered one of the most effective chemotherapy for the treatment of the LLC. The combination of two medications, including Fludarabine and Cyclophosphamide (CytoxanMD) or FC; Fludarabine and Rituximab (RituxanMD) or FR; and Fludarabine, cyclophosphamide and rituximab or FCR, is often used to treat patients whose LLC represents a moderate or high risk. Studies comparing Fludarabine-based treatments alone with those based on CF or with different FCR schemes have shown that the combination of drugs significantly increases the frequency of complete responses in patients with Have not been processed before. In clinical trials, additional studies are needed to determine which patients will benefit from a RCF-based treatment and which others will benefit from other treatments against the LLC. In addition, treatments combining fludarabine with other medications are currently being studied in the context of clinical trials.

Bendamustine (TreandaMD) is another type of chemotherapy that has been approved to treat the LLC in some provinces. Combinations of bendamustine with other drugs, including rituximab and Lenalidomide (RevlimidMD), are currently being studied in clinical trials for the treatment of patients with LLC.

Biological therapy

Monoclonal antibodies are proteins that are produced by biological Engineering in the laboratory. Each monoclonal antibody treatment is designed to recognize a specific molecule on a cell. Monoclonal antibody treatment targets the molecule and attaches to the cell, causing it to die.

Rituximab (RituxanMD) and alemtuzumab (CampathMD) monoclonal antibody treatments are used to treat people with LLC. The rituximab targets the CD20 molecule on the surface of the LLC cell and the alemtuzumab targets the CD52 molecule. The alemtuzumab is approved as the sole agent for the processing of the LLC. Rituximab and alemtuzumab have proven to be very effective in treating many people with LLC.

These therapies continue to be the subject of studies in the context of clinical trials. Other monoclonal antibodies, such as ofatumumab (ArzerraMD) and lumiliximab, are also being studied in clinical trials, either monotherapy or combined chemotherapy, as a treatment administered to patients been treated previously and to patients with refractory or recurrent LLC.

In most cases, chemotherapy affects both normal tissue cells and LLC cells. Monoclonal antibody treatment may affect some normal lymphocytes, but save most other cells. Although administering an antibody to an intravenous patient may cause a short period of fever, shivering or low blood pressure, patients generally face fewer disturbing side effects with the Monoclonal antibody treatment with chemotherapy.

The recurrent LLC or refractory

"LLC recurrent" is the term used to talk about a disease that has responded to treatment but has stopped responding after six months or more. "Refractory disease" is the term used to qualify an LLC that does not end with remission (but can stabilize) or to talk about an illness that is worsening within six months of the last treatment.

People who are treated for a recurrent or refractory LLC often enjoy a good quality of life during their remission years after they have been given additional treatment. The treatment indications for people with recurrent LLC are generally the same as for the treatments of people who have just been diagnosed with the disease.

People with Refractory LLC with a short period of progression after the first treatment and/or LLC cells with Del 17p often do not respond to standard chemotherapy. It is recommended for these people to talk to their doctor to decide if treatment in a clinical trial is a good solution for them. Clinical investigation protocols for drug therapies or stem cell allogeneic grafts may offer appropriate treatment options.