Chronic lymphocytic leukemia chemotherapy

Chemotherapy does not improve overall survival in early-stage chronic lymphocytic leukemia (CLL). 

Chronic lymphocytic leukemia (CLL) patients who receive fludarabine-based combination chemotherapy and rituximab may have long-term disease-free survival. 

Promotes recovery of neutrophils after chemotherapy Chronic lymphocytic leukemia, low-grade lymphomas... 

G. Other applications According to Micromedex, further potential roles for Rituxan include combination with chemotherapy in low-grade or intermediate-grade disease, first-line therapy of B-cell lymphoma, and use in other malignancies with CD20-antigen expression (e.g., chronic lymphocytic leukemia).Treat-... 

A 55-year-old man with chronic lymphocytic leukemia and rheumatoid arthritis took methotrexate for 4 years and developed a B cell non-Hodgkin s lymphoma in the shoulder and axillary lymph nodes he had Epstein-Barr viral antigens in the serum. After radiation and chemotherapy had failed, complete remission was achieved with a combination of rituximab and EPOCH (etoposide -I- prednisone -I- vincristine -I-cyclophosphamide + doxorubicin). 

Impaired humoral immunity Loss of protective barriers Multiple myeloma Chronic lymphocytic leukemia Splenectomy Immunosuppressive therapy (steroids, chemotherapy) Bacteria S. pneumoniae, H. influenzae, N. meningitidis... 

The management of chronic lymphocytic leukemia (CLL) is highly variable and may include delaying therapy in asymptomatic older patients, well-tolerated single-agent chemotherapy in symptomatic older patients, and more aggressive therapy in younger patients. 

O Brien SM, Kantarjian HM, Thomas DA, et al. Alemtuzumab as treatment for residual disease after chemotherapy in patients with chronic lymphocytic leukemia. Cancer 2003 98 2657-2663. 

A. Glucocorticoids Prednisone is the most commonly used glucocorticoid in cancer chemotherapy. The steroid has applications in dmg regimens for acute and chronic lymphocytic leukemia. Hodgkin s disease (MOPP regimen), and other lymphomas. Toxicity is described in Chapter 39. 

Successful concomitant treatment with clozapine and chemotherapy has been reported in a patient who had been stable on clozapine 500 mg/day and developed chronic lymphocytic leukemia years later and needed chemotherapy [79 ]. Because of concern about agranulocytosis during chemotherapy, clozapine was withdrawn, and she decompensated. After two cycles of chemotherapy, clozapine was restarted and titrated to the previous dose without sequelae. 

Uses Alemtuzumab is indicated for the treatment of patients with B-cell chronic lymphocytic leukemia for whom fludarabine combination chemotherapy is not appropriate. Alemtuzumab may also be effective in early multiple sclerosis [138 ], as induction therapy before transplantation [139 140 ], and in vasculitis associated with anti-neutro-phil cytoplasmic antibodies (ANCA) [141 ]. 

Examples (a) Cancerous tumors having high growth fractions which are foimd to give adequate response to chemotherapy are, namely Hodgkin s disease, Burkitt s lymphoma, Wilm s tumour, acute leukemia in children, choriocarcinoma, chronic myelogenous leukemia, lymphocytic leukemia, and breast cancer. 

---