In another interview from ASH 2013 that I just posted on my blog bkoffman.blogspot.com , Dr. John Pagel out of the Hutch and I discuss the role and the politics of the underuse of radioimmune therapy in CLL.
It is worth listening to just to hear his clever analogy of how the drugs work.
I believe that (they) have an under realized role as a mop up or consolidation therapy after the disease burden has been reduced. This is the model that has been successfully deployed in other lymphomas, but not in CLL.
More interviews to come from ASH as I get ready for ASCO 2014.
If you haven't already, please check out Dr. Sharman's latest post on his crazy schedule at the upcoming ASCO cll-nhl.com . We are planning to connect there for a quick interview, but finding a mutual time that works could be tough.
It is just great that we have so much research data to report on.
Stay strong
Brian
Admin: Removed brackets around web links so they will work. Added missing 'they' referring to aforementioned radioimmune therapy drugs.
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bkoffman
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It is worth remembering that those presenting with an early stage of SLL, (the lymphoma presentation of CLL), can be permanently cured of this cancer by selective radiation therapy of the cancerous lymph nodes. This approach becomes impractical when the cancer has spread, but if you have a way of selectively seeking out the cancer cells and targeting them with a radiation payload...
Wow, these are nice ideas. I wonder why they aren't being pursued more especially given the response rate. I guess for Zevalin they use two isotopes... Indium-111 and Yttrium-90. Indium-111 is for the imaging (it is a gamma emitter) and has a half-life of 2.80 days, so they have less than 5 days to image the tumors. Yttrium-90 is the "killer" since it is a beta emitter (high-energy electrons) and has a half-life of 64 hours. I guess we can't use Zevalin for pure blood cancers because then you would have all these tagged monoclonal B-cells beta-emitting throughout the blood stream for 5 days, and a lot of healthy cells would get wacked also. If the monoclonal B-cells are mostly bunched up in masses, then you have an ideal situation where the mass of them get wacked by the high-energy 2.3 MeV electrons and there is much less collateral damage to healthy tissue.
I know there are concerns in CLL, if the bone marrow density of lymphocytes exceeds 25%.
Dr. Hamblin noted
'I was particularly interested in the role of immuno-radiotherapy with Bexxar and Zevalin. I had always disregarded these agents in CLL because they cannot be given if there are more than 25% B cells in the bone marrow. But, of course , after therapy the B cells count in the bone marrow may be far less than that. There is still the question of whether marrow reserve is sufficient after chemotherapy to withstand the radio-isotope. I would need to consult an expert on this.'
Their role is strictly as a consolidation therapy, once the bone marrow is mostly cleaned out and the nodes are smaller so as to avoid too much collateral damage.
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Dr. John Allan - Chronic Lymphocytic Leukemia (CLL) Patients @Undetectable Measurable Residual Disease (MRD) after Ibrutinib Plus Venetoclax
