This publication is very interesting and describes the latest approaches to the treatment of CLL, relating them to the action of the immune system.
There are a number of new insights into the mechanism of CLL such as:
"CLL has undergone relevant clinical advances in the past decades, both in the understanding and the treatment of the disease. For many years, the focus of the therapeutic approaches has been to decrease the number of B-cells to reduce the tumor burden. New insights have shown that the interaction of leukemic cells with T-cells and other players of the immune system participate in the pathogenesis of the disease and contribute to a decrease of the overall health status of the patient, but this knowledge has not fully been applied to clinical practice yet."
The article examines all treatments used to date and their impact on immunity.
Thanks Yalokin, for that comprehensive and fairly up to date paper.
Snips
We need to further understand the roles of the different immune cells in the disease to apply therapeutic strategies that not only eliminate malignant B-cells but also restore the immune competence of the patient toward anti-tumor surveillance and immunity.
:
Keeping in mind that not only eliminating malignant B-cells, but also restoring the immune function may have significant positive consequences in the clinical practice, especially in CLL, that immune dysfunction is the cause of most of the complications for this disease. Also, understanding the relevance of the other immune players in CLL and how different treatments affect them would have a direct impact in successfully managing the disease. First, because this will allow us to avoid therapies that negatively impact the immune function, such as some chemotherapies. Second, because it will reduce the number of adverse events related to the immune dysfunction, for example infections, autoimmunity and second malignancies. Third, because this will facilitate the design of combination strategies, not only to reach deeper durable responses but to attack the disease from different fronts, with higher chances of synergistic and long-term effects. And four, it will allow us to successfully use the new generation of therapeutic strategies, most importantly immunotherapies and cell therapies, in CLL, so far inefficacious due to the immune dysfunction in CLL patients
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There is still need for more research to understand the effects of each treatment option (monotherapies and combinations) in the tumor environment and current technology can yield insightful data. Thus, it is essential to include broader biomarker analysis in clinical studies, that go beyond analysis of B-cells and include T-cell subpopulations and soluble factors at baseline and different timepoints.
CLL researchers see restoring our immune system as the last remaining challenge to providing a full cure for CLL.
Neil… I’ve been reading a lot of the various reports and related studies you have posted on treatments, supplements, vaccines, etc. (Thank you!), …and, your closing comment “CLL researchers see restoring our immune system as the last remaining challenge to providing a full cure for CLL” is of particular interest.
While the report that Yalokin just posted is really great, would you be aware of any recent reports that specifically address actual ways, beyond the treatment combinations that researchers are implementing?
From a practitioner’s perspective, has anyone with immune restoration focus/understanding noted or been recommending complimentary actions that patients can take on their own to strengthen their systems and improve treatment results?
Dr Michael Keating, who developed FCR at M.D. Anderson has established CLL Global Research cllglobal.org/ One of the goals of CLL Global Research is into immune restoration.
Exercise is arguably the best thing you can do strengthen your body for an easier time through treatment.
It’s taking awhile for this advice to be understood. When I was diagnosed, my family wanted me to “rest”; the CLL specialist wanted me to keep at it. When I crashed in 2019 towing my grandson (he was fine), they wanted me to “act my age”.
Thank you Neil. I reviewed the info on their site and signed up for their newsletter.
I found it interesting that the content under “Treatments” makes no mention of BTKi, whether as a mono therapy or combinations. Perhaps this is because their primary approach is the FCR.
The monoclonal and vaccine prospects are very interesting. I look forward to following.
Exercise…yes! During my husband’s “watch and wait” years and up to now, rather than give in to the fatigue, he’s worked out and simply rests intermittently as he stays active.
I think this is interesting: "Recently, it has been reported that immune microenvironment plays a significant role in progression of the disease in contrast to clonal evolution [5]."
"Ascorbic acid is a pro-oxidant that has been proven to overcome the protective effect of the microenvironment. It could potentiate the effects of ibrutinib, idelalisib and venetoclax in vitro and was able to reduce the viability of CD40L/IL-4-stimulated CLL cells [97]."
Excellent article! It helps seeing the treatments laid out and explained from the perspective of immune functions and implications. Thank you for finding and sharing this.
Hurray!!! In American football language, I would yell, "Another 1st down! CLL research is gaining yardage, moving closer to the goal line for the winning touchdown! Great research coaching strategy!" 🏈🙂Sandra
Ascorbic acid (vitamin C) is in lots of fruits and vegetables. Some citrus fruits (grapefruit and Seville oranges) are rich in another compound that can make the side effects of many drugs, including BTKi drugs like ibrutinib worse.
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