How I treat CLL up front.

Institute of Cancer, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, London, United Kingdom.
Blood (Impact Factor: 9.78). 10/2009; 115(2):187-97. DOI: 10.1182/blood-2009-08-207126
Source: PubMed

ABSTRACT Although chronic lymphocytic leukemia (CLL) remains incurable, over the past decade there have been major advances in understanding the pathophysiology of CLL and in the treatment of this disease. This has led to greatly increased response rates and durations of response but not yet improved survival. Advances in the use of prognostic factors that identify patients at high risk for progression have led us to the question whether there is still a role for a "watch and wait" approach in asymptomatic high-risk patients or whether they should be treated earlier in their disease course. Questions remain, including, what is the optimal first-line treatment and its timing and is there any role of maintenance therapy or stem cell transplantation in this disease? CLL is a disease of the elderly and not all patients are eligible for aggressive up-front chemoimmunotherapy regimens, so what is the optimal treatment approach for more frail elderly patients? It is highly likely that our treatment approaches will continue to evolve as the results of ongoing clinical trials are released and that further improvements in the outcome of this disease will result from identification of therapies that target the underlying pathophysiology of CLL.

  • [Show abstract] [Hide abstract]
    ABSTRACT: We report our experience on bendamustine and rituximab (BR) combination in 26 patients with chronic lymphocytic leukemia (CLL) complicated by autoimmune hemolytic anemia (AIHA). At the time of BR initiation, 88% of the patients had already been treated for AIHA and CLL was progressive regardless of AIHA in all patients but one. Overall response rates were 81% for AIHA and 77% for CLL. Median time to next treatment was 28.3 months and 26.2 months for AIHA and CLL respectively. BR therapy may represent a good and safe therapeutic option in this setting where adequate control of CLL seems important for long-term AIHA response. This article is protected by copyright. All rights reserved. Copyright © 2014 Wiley Periodicals, Inc., A Wiley Company.
    American Journal of Hematology 11/2014; · 3.48 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Due to the unavailability of a common cancer incidence database in Pakistan, the cancer incidence data from nuclear medicine and oncology institutes have been gathered and presented. Methods: The cancer incidence data for the last 27 years (1984-2011) is included to present a data set of male and female patients. The data analysis concerning occurrence, trends of common cancers in male and female patients, stage-wise distribution, and mortality/follow-up cases is also incorporated for the last 7 years (2004-2011). Results and Conclusions: The cancer incidence rates for head and neck (13.41 percent), brain tumors (10.90 percent), and non-Hodgkin lymphoma (NHL, 9.70 percent) were found to be the highest in male patients, whereas breast cancer (45 percent), ovary tumors (6.6 percent), and head and neck (6.21 percent) cancer incidence rates were observed to be the most common in female patients. The age range distribution of diagnosed and treated patients in conjunction with the percentage contribution of cancer-treated patients from different cities of Punjab at the Institute of Nuclear Medicine and Oncology, Lahore is also included. Leukemia has been found the most common cancer for the age group of 1-12 years. It has been identified that the maximum number of diagnosed cases were found in the age range of 51-60 years for male and 41-50 years for female cancer patients.
    Journal of registry management. 01/2014; 41(2):85-90.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Oxidative stress (OS) has been characterized by an imbalance between the production of reactive oxygen species (ROS) and a biological system¿s ability to repair oxidative damage or to neutralize the reactive intermediates including peroxides and free radicals. High ROS production has been associated with significant decrease in antioxidant defense mechanisms leading to protein, lipid and DNA damage and subsequent disruption of cellular functions. In humans, OS has been reported to play a role in the pathogenesis of neurodegenerative diseases such as Alzheimer¿s disease, Huntington¿s disease, Lou Gehrig¿s disease, multiple sclerosis and Parkinson¿s disease, as well as atherosclerosis, autism, cancer, heart failure, and myocardial infarction. Although OS has been linked to the etiology and development of chronic diseases, many chemotherapeutic drugs have been shown to exert their biologic activity through induction of OS in affected cells. This review highlights the controversial role of OS in the development and progression of leukemia cancer and the therapeutic application of increased OS and antioxidant approaches to the treatment of leukemia patients.
    Journal of Experimental & Clinical Cancer Research 12/2014; 33(1):106. · 3.27 Impact Factor

Full-text (2 Sources)

Available from
Jun 2, 2014