Cannabis and CLL: symptom management?

[spanglem123]

Anyone have any experience with cannabis improving their symptoms?

[AussieNeil Administrator]

Are you asking about CLL related symptoms or for reducing the symptoms of other health conditions? Recent research has indicated the need for caution when taking cannabinoids if you have CLL, particularly if you are in treatment. That's because cannabinoids can interfere with BTK inhibitors (Acalabrutinib, Ibrutinib, etc) and other prescription drugs, including prednisone. CBD oil is a potent inhibitor of CYP3A4, medicinalgenomics.com/wp-co... the Cytochrome P 450 liver enzyme responsible for metabolizing many drugs. Using CBD can effectively cause overdosing on various prescription drugs that use that pathway, thereby increasing the associated side effects of those drugs.

If you aren't on treatment for CLL, then these two papers give pause for thought. Firstly, as reported in 2019, cannabinoids apparently encourage the migration of CLL cells from the blood supply into the nodes and spleen, where CLL cells actively divide (they are dormant in the blood supply) and the bone marrow, where they suppress blood cell production. healthunlocked.com/cllsuppo... That may give the false impression from observing changes in your lymphocyte count, that taking CBD oil is helping your CLL, but it may be redistributing the CLL tumour burden to where it can do more damage to your health.

Secondly, Cannabinoid Receptors Are Overexpressed in CLL but of Limited Potential for Therapeutic Exploitation, from PLOS1 in June 2016: journals.plos.org/plosone/a...

From the Discussion section: "While we did find that cannabinoids reduced viability of CLL primary cells considerably independent of CNR mRNA expression, we found healthy cells to be affected to the same degree. Thus—and in contrast to other malignancies—our data suggest cannabinoids to be of poor therapeutic potential for treatment of CLL although CNR1 mRNA expression could be determined as novel prognostic marker. Their role in CLL notwithstanding, cannabinoids may still proof useful for anti-tumor therapy in other, selected hematologic malignancies and solid tumors in which the potential of cannabinoids will have to be studied accordingly." (My emphasis) This wasn't a small investigation either, as 107 patients with CLL supported the research.

I do know of research where a cannabinoid was used concurrently with chemotherapy where it was shown to synergistically improve the treatment effectiveness of an acute leukaemia, which just goes to show how important it is to verify whether promising cannabis research is specific to CLL!

Neil

[spanglem123 in reply to AussieNeil]

It definitely helps with sleep, anxiety. Also helps my belly by relaxing smooth muscle when I have terrible LUQ-spleen pain.

[AussieNeil Administrator in reply to spanglem123]

I presume you are regularly using it? If so, given the possibility that you may be speeding your CLL progression, you might consider whether alternative options to manage those symptoms may be more suitable. You can use the spreadsheet templates covered in this post to see if switching to an alternative results in any difference in your blood counts. I would be looking for changes in your lymphocyte, haemoglobin and platelet trends. I would hope that they aren't obvious in under 3 months off then on cannabis, but as with all things CLL related, we are all different. healthunlocked.com/cllsuppo...

What I would be most concerned about is the shift in tumour burden. It's not easy to assess changes in your nodes and spleen. Bone marrow changes are even harder to assess unless infiltration is affecting blood cell production.

There has been a huge amount of hype regarding benefits of cannabis use and cancer. With CLL specific symptoms, reasonable evidence only exists for nausea relief when in treatment and pain relief. Generally other remedies are found to be more effective for most of us for these situations. It doesn't help that CBD oil concentration often doesn't match what is claimed - usually it's under the claimed strength. See healio.com/primary-care/pai... Also the medical profession aren't generally that knowledgeable about it, particularly with respect to CLL.

Neil