Re: Nodes without Marrow involvement

[Guest guest]

Wanda, while you're awaiting an answer, let me ask you these questions

during the interim:

You state having FCR last year, in what month did you finish?

Are and/or have you been taking rituximab and/or alemtuzimab and/or any

other drug since then?

If so please provide information.

..... had FCR last year and after 8 months had a BMB which showed MRD

positive. Another BMB in May showed NO MRD as well as the most recent

BMB taken this Nov. .....

[Guest guest]

Wanda,

There are several possibilities regarding the possibility of having an

MRD negative bone marrow biopsy while having lymph nodes increasing in

size.

1. The MRD assay is not perfect and is falsely negative.

2. The lymph nodes are not due to CLL but something else and you really

are in remission.

3. The bone marrow is clear, but the lymph nodes are not. This last

one is important to understand because when data has been generated

using MRD status, it was done in patients who had achieved a CR. Thus,

the data generated does not include patients who have lymphadenopathy

but normal bone marrow. Thus, the " benefit " of being MRD negative is

less since there is CLL in the lymph node.

Rick Furman

>

> Post goes out to Dr. Furman or anyone who has knowledge of this. I

had

> FCR last year and after 8 months had a BMB which showed MRD positive.

> Another BMB in May showed NO MRD as well as the most recent BMB taken

> this Nov. My specialist says he hasn't really seen this change before

> in the status but contributes it to the cells dying off at a slower

> rate. My question is my nodes are continuing in all areas and more

> seem to be popping up. Largest is in my groin at about 1.5. How can

I

> have active nodual involvement with no marrow involvement?

> Thanks

> Wanda

>

[Guest guest]

3. The bone marrow is clear, but the lymph nodes are not. This last one is important to understand because when data has been generated using MRD status, it was done in patients who had achieved a CR. Thus, the data generated does not include patients who have lymphadenopathy but normal bone marrow. Thus, the "benefit" of being MRD negative is less since there is CLL in the lymph node.Rick Furman

Thank for this reply Dr. Furman,

I am on this category for the first time in my CLL life my marrow is clear a wonderful feleing marrow producing all the good cells, but my nodes are there, at the moment we are treating them with HDMP, I had my first week two weeks ago and the next one will be 5th January, I am not that confident the nodes will go all together, they have been very stuborn throughout my CLL life, and never went away during any treatment, also my marrow only got partially improved with all treatment and got heavily saturated again within a few months, this time I am amased that Campath cleared the marrow so well with only 18 doses, so we are still fighting the nodes.

regards

Chonette (UK)

Chonette dx 10-02 (aged 57)unmutated, CD38 19%, ZAP70 9%,2004 Prednisolone 8 weeks 50 mg. a day,2005 Prednisolone 8 weeks 50 mg.a day, followed bylow doses chlorambucil (2 mg.),2006 Rituximab and low doses chlorambucil (6 mg. a day 14 days on 14 daysoff) 6 rounds,2007 Low doses Rituximab,2007 Fluradabine Lite, HDMP,. Rituximab 200 mg. monthly (5 rounds)

2007 Cataracts removed on both eye. Cataracts were due to steroids.Partial Remission, multiple pea size nodes on neck,Started 16 week Campath/HDMP Protocol in June 2008, to follow SCTCMV activation plus two other infections end week 8th of Campath.Hopitalised for 4 weeks. 2 months gap to allow body to recoverDec 2008 - HDMP to reduce nodes, bone marrow clean - no more Campath neededSCT penciled for February

[Guest guest]

Wanda, It seems that CLL cells may be " programmed " to home to one

tissue or another. Like salmon to a spawning site. Or that signals

in the host environment (the river) dictates migration ...

I can't say if this explains what you are observing of course .. or

if the nodal involvment is from an accumulation of CLL cells. I think

only a biospy could determine that and as Dr. Furman noted it could

be from something else, perhaps a reaction to infection could also

explain enlarged nodes.

See for a technical discussion of CLL migration in the opposite way:

http://www.citeulike.org/user/philill/article/950497

All the best,

Karl

---

>

> Post goes out to Dr. Furman or anyone who has knowledge of this. I

had

> FCR last year and after 8 months had a BMB which showed MRD

positive.

> Another BMB in May showed NO MRD as well as the most recent BMB

taken

> this Nov. My specialist says he hasn't really seen this change

before

> in the status but contributes it to the cells dying off at a slower

> rate. My question is my nodes are continuing in all areas and more

> seem to be popping up. Largest is in my groin at about 1.5. How

can I

> have active nodual involvement with no marrow involvement?

> Thanks

> Wanda

>

[Guest guest]

Thanks to all who responded. I have had no other treatment except for

the FCR which I only had 3 rounds of due to PC pneumonia. The

treatment ended end of April 07 and I had a BMB that Dec 07 and now

again a year later in Nov 08 My nodes are continuing to grow and I've

had no current infections- so I'm thinking it's the SLL/CLL acting up

again. Thank you for all the help

Wanda