Distinct immune composition in lymph node and peripheral blood of CLL patients is reshaped during venetoclax treatment

[cllady01]

Key points:

1. The immunosuppressive footprint of CLL on nonmalignant lymphocytes is more pronounced in the lymph node microenvironment.

2. Venetoclax combination treatment reduces immunosuppressive features of CLL, suggesting immune recovery after elimination of tumor cells.

Understanding the effects of novel treatment regimens on the immune system is particularly important considering the fact that infections remain a leading cause of morbidity and mortality in CLL.35,36 In addition, knowledge about how venetoclax impacts lymphocytes may be valuable in designing future combination strategies and shed light on possible risks associated with long-term treatment. Eradication of the malignant clone potentially allows recovery of immune responses and, thus, immunosurveillance.

ncbi.nlm.nih.gov/pmc/articl...

[PlanetaryKim]

This is good news - I think. I'm glad to be on venetoclax... even if it is causing me interminable low-grade fever ("pyrexia").

[Sushibruno]

So in other words the combinations are working much better then single agents and therefore less infections? I'm a cll dummy and it's hard to understand these things for me🙊.

[cllady01 Former Volunteer in reply to Sushibruno]

Sushi, Venetoclax combos have the potential of not suppressing the immune system forever. This paper suggests that after the CLL tumor cells are destroyed, the immune system will recover. (Not a medical or scientist, but that is how I interpret this.

[Sushibruno in reply to cllady01]

Thank you, cllady01

[PlanetaryKim in reply to cllady01]

That's very heartening!

[Newdawn Administrator]

Good find cllady! Reassuring content especially at the moment! 👍

Newdawn

[cllady01 Former Volunteer in reply to Newdawn]

And may it continue to be reassuring!

[Smakwater]

cllady01,

Very encouraging.

Although a complete understanding of the expected biological measures are above my level of knowledge, It has been my understanding prior to enrolling in the O+V trial that there was a high expectation for cell recovery, a deep remission, and no damage to DNA. However, there is much more still under observation.

At 3 1/2 months post therapy I am probably being a bit premature in my personal expectations, as I was hoping that all of my labs would have returned to normal. I am pleased with my current results as I should be, and I remain very hopeful for a full immune recovery by 6 - 12 months.

My WBC/Lymphocytes remain mildly low which is reflected in the neutrophils hovering around 1.5 - 1.8, as well as IgA and IgM under acceptable levels. Other than that everything else is well in range.

I still cannot acquire a clear answer as to whether a full b cell recovery is expected which would also influence the recovery of neutrophils and immunoglobulins.

I suppose that we as trial participants are still in part one element of the ongoing measure.

No doubt that in many cases better than anything that has yet come. 💫

JM

[Elam]

I am on the trial also. About. 8 months in. My neut# dropped below 1 about a month ago and they took me off Vent. After 1 week off neut# went to about 1.5 and 2 weeks about 3.4. So I am back on at 300 mg rather than 400 mg. After 1 week at 300 mg down to about 2.5 , still acceptable. This shows my immune system recovered quickly when off the Vent. More blood work will tell if I neef to reduce to 200mg.

[Smakwater in reply to Elam]

Elam,

When my neutrophils dropped at about 8 months to .97 I was given a G-csf that boosted them back to 6.4. This lasted for about two months, and then they hovered around 1 - 1.4 until I discontinued treatment. I was able to maintain full dose venclexta until treatment stopped.

Hope you have the best results possible.

JM

[Elam]

Thanks. What type of drug is G-cfs ?

[Hidden in reply to Elam]

granulocyte colony stimulating factors producing stem cell activity, which produce neutrophils:

Common brand names:

Neulasta

Neupogen

Zarxio

drugs.com/drug-class/colony...