New strategies for chronic lymphocytic leukemia – WWN

New strategies for chronic lymphocytic leukemia – WWN

You can’t cure yourself definitively yet, but you can live (and well) for many years after a diagnosis leukemia chronic lymphatic. There are patients with a small and stable disease over time, who do not require treatment, in which the tumor has no impact on life expectancy. For others, however, the new biological therapies, without chemotherapy, and the improvement of supportive therapies have significantly extended survival. So there was a improvement in people’s life expectancy with this form of leukemia, which mostly strikes around the age of 70, but which can also be diagnosed in much younger patients. The change in perspectives for patients, who now live better and longer, was discussed during the event «New strategies for chronic lymphocytic leukemia» scheduled at Health Time of Corriere della Sera on Sunday 12 November.

Treatments chosen by evaluating the individual case

«It is a slow-growing form of leukemia, which can often be kept “under observation” because it does not cause symptoms and does not progress, or does so very slowly – he explained Francesca Romana Mauro, specialist in Hematology and associate professor at Sapienza University -. It is often discovered accidentally in blood tests done for other reasons that show too many lymphocytes (a type of white blood cell). The course of the disease varies from person to person: some have a very stable disease that does not require any treatment or requires it only after years, while in other cases timely treatment is needed right from the diagnosis. It all depends on the biological characteristics of the leukemic cells present in the individual case, which condition behavior with a more or less “fast” attitude towards growth.”

Treatments and remission

When it becomes necessary to intervene with a cure, today there are several options. In the past the most frequent treatment was combination of chemotherapy and monoclonal antibodies (chemo-immunotherapy).
«In recent years they have been developed new drugs, very effective and “intelligent” which prevent the expansion of cells by blocking their growth mechanisms – said the hematologist Marco Vignetti, president of the GIMEMA Foundation «Franco Mandelli» -. With some drugs, optimal long-lasting disease control can be achieved, and in others even deep remissions. This is the goal that we have achieved today thanks to research: we have managed to rewrite the history of many people who fall ill with chronic lymphocytic leukemia and who now live longer and better, with fewer side effects, and can return to leading a normal life as soon as possible, regaining their daily lives.” So today we can talk about “remission” of the tumor, a very important goal in the majority of the approximately three thousand Italians who every year discover that they have chronic lymphocytic leukemia: this is, in fact, the term used when the neoplasm, once the therapies, is absent and is no longer detected by any control tests. And it can stay that way for months, even years. Progress has also been made on the diagnosis front which helps specialists to better identify the aggressiveness of the disease in each individual person, to better calibrate the treatment and keep the evolution of the disease under control over time.

Living with a chronic illness

What does it mean to live with a chronic illness? He gave it a reading Davide Petruzzelli, president of La Lampada Aladino Onlus and member of the national executive of the Italian Federation of Volunteer Associations in Oncology (FAVO): «First of all it is important to be followed in centers with experience: relying on competent specialists can not only make a big difference in obtaining the most suitable therapies, but also in receiving the right support on other necessary problems, even more relevant if you have a pathology chronic, with which one must live throughout one’s life.” By virtue of his experience as a former patient with lymphoma, treated with various lines of treatment between 1996 and 1999, Davide left some useful advice to patients: «The path must be tackled one step at a time, like an endurance race, not of speed – he suggested -. Greater awareness of the disease allows the patient to have a better decision-making ability and sharing choices, to manage anxiety and to adhere more effectively to the treatment path. It is then better not to withdraw into oneself, but to keep important relationships and sociability alive, one’s passions, practice sports if conditions allow it and stay mentally active. Remembering that the encounter with the disease can also be an opportunity to (re)discover oneself and others. Living with a pathology does not necessarily have to be synonymous with giving up your daily life or saying goodbye to small or large goals. Psychological support can be a valid help in regaining possession of what the disease tries to take away, as can turning to a patient association where, in addition to practical help, one can find sharing one’s experiences.”

New treatments

A “normal” life is also possible for patients with Lchronic lymphocytic eukemia, for which much has changed in terms of therapies. «Chemotherapy, a very valid option, but characterized by short and long-term toxicity problems, has today been replaced mostly by biological drugs – explained Francesca Mauro -. Today we have oral biologics that are able to intervene on some mechanisms that favor the proliferation and survival of disease cells. Some of these drugs, BTK (Bruton’s tyrosine kinase) inhibitors, reduce the disease while maintaining control as long as they are taken continuously every day. They can have a very long-lasting effectiveness over time, but some side effects can lead some patients to have to stop treatment prematurely. Another drug – continued the expert -, the inhibitor of the BCL2 protein which promotes the survival of diseased cells over time, can give very profound responses in which the diseased cells are no longer identifiable even with very fine laboratory methods. This depth of responses, these remissions in the absence of residual disease, are not cures, but allow treatment to be suspended after a fixed duration of treatment of 12 or 24 months. The patient can thus benefit from a very long-lasting period free from the need for a new treatment. Like all treatments, these too can present side effects that require careful medical supervision, especially in the early stages of treatment.”

Fixed or continuous therapy

Is it better to have a fixed or continuous duration therapy? «Today we do not have data deriving from controlled studies that allow us to say whether a certain type of therapy (of continuous or fixed duration) is superior to the other – replied the expert -. Some forms of chronic lymphocytic leukemia, characterized by a very unfavorable biological profile, could be better controlled by continuous therapy. Since there is no data on the superiority of one therapy over the other, the choice is based on the characteristics of the disease, the patient’s characteristics and comorbidities and also on the patient’s preferences. Some feel calmer if they are treated daily, while others feel “forced” by the treatment and are happy if they can suspend it and feel free from something that reminds them of being ill. Both therapeutic choices can precede or follow the other, without an obvious impact on the chances of response. But here too, we have no clear recommendations deriving from comparative therapeutic studies.”

Where to get treatment

«The course of chronic lymphocytic leukemia can not only change over the months and years, but being a pathology of the immune system it can lead to various consequences in the lives of patients – concluded Vignetti -. For example, it can cause a lower immune response against viruses and bacteria. Due to immune deficiency, patients may not respond optimally to vaccinations, or even not be immunized. In some patients, it may be necessary to periodically administer immunoglobulins, with the aim of compensating for the reduced immune response to infections. For this and many other reasons, those who have to live with this neoplasm must be followed in a Hematology center with specific expertise in the treatment of this disease and with a network of specialists with experience in the various problems that may arise.” In short, we need a hospital that has the multidisciplinary group preparation made up of several specialists: the infectious disease specialist, the cardiologist, the surgeon, to name a few. The radiologist and the sonographer must be present who periodically, during the checks, evaluate the presence or absence of the disease as their assessments can lead to different types of decisions that the hematologist will make regarding treatment.

November 12, 2023 (changed November 12, 2023 | 4:50 pm)


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