There was hope that non-chemo CLL treatments would avoid the increased risk of subsequent secondary cancers, with concern about Myelodysplasia Syndromes and Acute Lymphocytic Leukaemia (MDS and ALL) of particular concern with FCR, due to possible DNA damage to bone marrow stem cells. It was thought that the lack of DNA damage with Ibrutinib and Acalabrutinib would prevent this risk. Unfortunately, it may be that all CLL treatments carry with them an inherent higher risk of secondary cancers, due to the impact treatments have on our immune system vigilance against secondary cancers. Note that these findings are correlations and more studies are needed, but if you needed an incentive to quit smoking, perhaps this report will help.
"David Bond, MD, assistant professor at the Ohio State University, discusses 2 key findings from a recent study investigating the risk of developing a second cancer in patients with chronic lymphocytic leukemia (CLL) treated with a BTK inhibitor. The study analyzed 691 patients with CLL who were treated with either acalabrutinib (Calquence) or ibrutinib (Imbruvica) and developed a second primary malignancy. The rate of developing a second primary neoplasia in patients with CLL treated with this class of agents was 7.6% at 3 years.
Bond says patients with prior tobacco exposure are known to have an increased risk of cancer development, particularly in lung cancer and bladder cancer. These results validate the importance of counseling patients with CLL on treatment with BTK inhibitors regarding tobacco.
a low CD8 count at baseline was associated with an increased risk of developing a second cancer. These data are the first to demonstrate this in CLL to date, but points to the close correlation between immune function and the risk of developing a second cancer, says Bond."
CD8 cells are cytotoxic T-cells and it is well recognised that CLL can affect the number of CD8 cells and the CD4:CD8 ratio, per this 2010 paper: ncbi.nlm.nih.gov/pubmed/208... Higher CD8 count was associated with significantly higher median time of survival of patients (149.33 vs. 82.06 months).
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