Do all novel drugs "clear" CLL cells in blood, lymph nodes and bone marrow?

[mantana]

Do all novel drugs (non-chemotherapy) "clear" CLL cells in blood, lymph nodes and bone marrow?

Or perhaps some drugs clear CLL cells only in blood, but are unable to get into bone marrow?

[lankisterguy Volunteer]

Hi mantana,

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I asked a similar question of Dr. Furman, and he explained that the different drugs go about killing CLL in different ways, but since the CLL cells move around on a periodic basis, the long term effect is similar.

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For example the BTK and Pi3K inhibitors ( Ibrutinib, Acalabrutinib, Idelalisib, etc.) cause the nodes and spleen to empty quickly, and for some patients the ALC will rise, and then take a longer time to decline. Those inhibitors don't kill the CLL cells directly, but by keeping them from hiding in the nodes and spleen cause them to die faster.

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Other drugs like Venetoclax primarily affect the CLL cells in the blood, so the ALC can crash suddenly, thus the risk of TLS (Tumor Lysis Syndrome). But the nodes and spleen decline more slowly. Eventually the nodes and marrow occupation decrease as the normal movement of cells empty out the CLL cells.

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Len

[bkoffman CLL CURE Hero]

Yes, though some are better at clearing different compartments Brian Koffman CLL Society

[cllady01 Former Volunteer]

And, so we don't forget the CD20 combined with Venetoclax in some CLL patients:

Obninutuzumab, done at a pace that can avoid tumor lysis, helps with the slowness factor of Venetoclax by clearing the spleen and nodes so Venetoclax can do its work and we, thus have a treatment that can be over within 12 months.