The Mayo study

[Guest guest]

Folks - let me go back to the study discussed by Karl several days ago. This mentioned the study at Mayo where they set out to show that in high risk patients early "benign" treatment (Campath+Rituxan) delays the need for more aggressive therapy.

I have questioned Dr. Zent, the lead author, and he has pointed out that they did, in a fairly small sample, show that this treatment delays the need for more aggressive therapy by about two years. A larger sample randomized study would be needed to conclusively prove this extension in time.

The results are given in CANCER, October 15, 2008, volume 113, number 8, pages 2110-2118. I'm not sure that I have the right to reproduce this article, but you can probably get it on the net. I hope they don't throw me in jail for quoting this section from page 2116:

"The median time from the dateof CLL diagnosis to the date of initial treatment, asrequired by NCI-WG96 criteria, was significantly longerin patients who received with alemtuzumab andrituximab (4.4 years; 95% CI, 3.1-6.7 years) than inthe comparison group (1.9 years; 95% CI, 1.5-2.7years; P 5.001) (Fig. 6). In a multivariate model,treatment with alemtuzumab and rituximab was asignificant predictor of time from diagnosis to initialtreatment required by NCI-WG96 criteria afteradjusting for age, stage, and risk group (P 5 .001)(Table 4)."

This is really the crux of the matter. But, as Dr. Zent says, more work would need to be done to establish a definite conclusion.

I think this work is very interesting, and merits attention (with a little bit of skepticism), based on the fact that we really do not know the long term result of this kind of "delaying treatment". Although, logically, the longer you can go without aggressive TX the better for your old body. Changes in longevity, of course, have not been discussed at all, as the study was just recently performed.

(Our thanks to Dr. Zent!!)

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