Re: ?s Re IVIg & Acitretin

[Guest guest]

In a message dated 12/31/2007 8:06:40 A.M. Mountain Standard Time, rrfurman@... writes:

For someone who has several skin cancers (not precancerous lesions), it might be interesting to see if acitretin has an effect,

Yes, it would be interesting. Perhaps you will follow through, since the overall attitude toward shin cancers in CLL lacks any momentum other than slash and burn. In the interim, I gearing up to arm wrestle my local hem/onc to try it.

BTW, I have a copy of your 2005 presentation on CLL/SLL given at some L & L Society meeting that slips my mind at the moment. Dx in 2003, it hit about the time I could actually understand it and I've passed it along many times. Kudos to the person that captured it in a PresentME format and mostly to you for the succinct summary. Much appreciated. It continues to live on.

When you have the time, I'm wondering if you would comment on Abstract # 7092 ASCO 2007 Meeting re low dose Campath for maintenance treatment. Seems like CD4-T-cells at 50% of baseline for about a year, (and as we've read before, those that return are shadows are their former selves), might leave a patient wide open to a secondary cancer. Or am I off the mark there? Since this study used 30 mg at various schedules, could you foresee 15 mg being a viable tool?

Again thanks for your insight.

Ann

Albuquerque, NM See AOL's top rated recipes and easy ways to stay in shape for winter.

[Guest guest]

Ann,

There is some role for IV Ig in patients with normal IgG levels who

suffer from chronic infections. IgG is the most important

immunoglobulin. Still, with normal IgG levels, there are some CLL

patients who still suffer from chronic infections, particularly

sinusitis and bronchitis. The most important thing is to make sure

you are not missing another cause of the infections. If there are

not other causes to be corrected, then IV Ig is a potentially helpful

agent.

There are very few side effects from the IV Ig. The most significant

are cost and inconvenience. There is also the possibility of kidney

damage, but this is quite rare.

Regarding acitretin, there are interesting data in very high risk

poputlations. I am not sure that the data are mature enough or the

risk great enough to warrant treating CLL patients prophylactically.

We do not know the effects of acitretin on CLL and fortunately, the

skin cancers CLL patients develop tend to be the ones easily

treated. I do recommend all of my CLL patients once they start

treatment or have previously developed a skin cancer to see a

dermatologist every six months. For someone who has several skin

cancers (not precancerous lesions), it might be interesting to see if

acitretin has an effect, but this should be in the context of a

clinical trial.

Rick Furman, MD

>

> How advisable is it for someone with chronic sinus and upper

> respiratory infections to receive IVIg with IgG labs within normal

> range, IgA slighly below normal, and IgM significantly low? Will

it

> help get the infections under control? Are risks associated with

IVIg

> when IgG is within normal range?

>

> There are several PubMed abstracts that reference the use of

acitretin

> (an oral retinoid) for preventing skin cancers in transplant

patients,

> who are on immunosupressive therapy. Is it worth considering for

CLL

> patients who suffer from skin cancer, particularily during or right

> after treatment?

>

> Thanks for a response.

>

> Ann

> Albuquerque, NM

>

[Guest guest]

Ann,

The abstract from the 2007 ASCO meeting reports on the potential role

of maintenance alemtuzumab in CLL patients.

The first thing to remember when reading this abstract is the use

of " maintenance " . The authors do not report the clinical response

achieved with chemotherapy prior to receiving the alemtuzumab. There

was a large CALGB trial (large cancer clinical trials collaborative

group)that demonstrated there is a great difference seen when

alemtuzumab is given to patients in CR versus PR as

consolidation. " Consolidation " , giving alemtuzumab to patients who

have not yet had a CR is much safer. The patients who achieved a CR

and received alemtuzumab had a tremendously increased risk of serious

infections.

The authors also do not report on whether there was any clinical

benefit obtained. They only report on the CD4 counts. They also

only show the CD4 counts in terms of percentages. The 50% level

sighted is approximately 190 cell/microliter. This is a low enough

number that patients could run into problems.

My personal belief is the risk of infections with alemtuzumab relates

to the length of time one is on it as well as the amount of disease

burden present. We still do not know if the use of alemtuzumab to

take someone from a PR to a CR translates into a clinical benefit,

althought I suspect it should.

Rick Furman

>

>

> In a message dated 12/31/2007 8:06:40 A.M. Mountain Standard Time,

> rrfurman@... writes:

>

> For someone who has several skin

> cancers (not precancerous lesions), it might be interesting to see

if

> acitretin has an effect,

>

>

> Yes, it would be interesting. Perhaps you will follow through,

since the

> overall attitude toward shin cancers in CLL lacks any momentum

other than slash

> and burn. In the interim, I gearing up to arm wrestle my local

hem/onc to

> try it.

>

> BTW, I have a copy of your 2005 presentation on CLL/SLL given at

some L & L

> Society meeting that slips my mind at the moment. Dx in 2003, it

hit about

> the time I could actually understand it and I've passed it along

many times.

> Kudos to the person that captured it in a PresentME format and

mostly to you

> for the succinct summary. Much appreciated. It continues to live

on.

>

> When you have the time, I'm wondering if you would comment on

Abstract #

> 7092 ASCO 2007 Meeting re low dose Campath for maintenance

treatment. Seems

> like CD4-T-cells at 50% of baseline for about a year, (and as

we've read before,

> those that return are shadows are their former selves), might

leave a

> patient wide open to a secondary cancer. Or am I off the mark

there? Since this

> study used 30 mg at various schedules, could you foresee 15 mg

being a viable

> tool?

>

> Again thanks for your insight.

>

> Ann

> Albuquerque, NM

>

>

>

> **************************************See AOL's top rated recipes

> (http://food.aol.com/top-rated-recipes?NCID=aoltop00030000000004)

>

[Guest guest]

Dr. Furman:

Thanks for your insight. Excellent.

Ann

Albuquerque, NMStart the year off right. Easy ways to stay in shape in the new year.