CT scan results after 3 cycles BR

[TOFK]

Hello all,

My dad (12 trisomy and unmutated) has finished his 3rd BR cycle. The CT scan shows a reduction of the lymph nodes by 50%-60% (the biggest lymph node was 15 cm in his belly). The hematologist was happy with the results. What do you guys think about the results? We have 3 rounds left, is complete remission still possible?

Thanks!

[lankisterguy Volunteer]

Hi TOFK,

I checked your past postings and see that your 69 year old Dad is from Iran and is being treated in the Netherlands. And you did get a 2nd opinion from another hospital, that displeased the first doctor. I assume his renal function is now stable, and there have not been any further problems with the BR Chemo treatments.

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If your Dad's Trisomy 12 Unmutated behaves like mine (and that may not be true- as even among people with the same markers the results vary a lot), he may keep getting good results from treatment. But reducing a 15 cm node to less than 1.5cm is quite a drop to reach a full CR. My own 9 cm nodes did get below 1 cm in about 3 months on Idelalisib / Zydelig and withing 5 weeks on Venetoclax. I don't know how effective his current treatment might be in shrinking that huge node.

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Whether your Dad gets a full CR or a PR from his current treatment is hard to predict. With either outcome his Trisomy 12 UnMutated may have some years before he needs treatment again. Let's all hope he gets good results and can avoid treatment for many years.

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Len

[TOFK in reply to lankisterguy]

Hi Len,

Thank you very much for your reply. His renal function is still not perfect but is getting beter and there are no big issues with the chemo.

All the lymph nodes has decreased in size and the biggest node is now 7-8 cm instead of 15 cm. Hopefully it will decrease more since we have 3 rounds left. I hoped for CR after this 3 round, but you’re right from 15 cm to 1,5 is quite a drop even after 6 rounds.

Thanks again!

[Jm954 Administrator]

Hi there,

15cm is regarded as bulky disease and that nodal mass may well be necrotic (essentially dead tissue) in the middle, making it difficult to reduce in size completely. The good thing is that the residual tissue that is not reducing is already dead and if all the other nodes return to normal and his bone marrow is clear then it would most likely be considered a complete remission.

Generally the response after 3 cycles is not completely predictive of overall response as responses do improve with further cycles of BR.

I found this paper, it's old at 2014 but it's a good one regarding BR treatment and also states that poor renal function is not a problem with this treatment. I hope you find it helpful

bloodjournal.org/content/12...

Let us know how your dad is.

with very best wishes

Jackie

[TOFK in reply to Jm954]

Hi Jackie,

Many thanks for the useful paper. The hematologist didn’t mention anything about bulky disease. Is bulky disease related to poor prognosis?

My dad feels great, we went on holiday to south France one week after the 3 round. But he lost some weight since the start of the chemo.

Best wishes.

[Jm954 Administrator in reply to TOFK]

Bulky disease can be a poor prognostic indicator but CLL is so variable that nothing is certain.

I’m glad he’s feeling good, enjoying life and doing things that make him happy even whilst on chemo. That’s a great attitude!

Take care,

Jackie

[TOFK in reply to Jm954]

Thank you Jackie!