Thoughts about LA

[Guest guest]

As stated last week, I promised to provide some medical impressions from the LA Seminar:

1. Everyone shows Kaplan-Meyer curves. (Those are those horrible things that show survival percentage against time.) In my opinion these are friend for doctors' meetings, but have little place in presentations to patients. Certain curves, for example comparing time to relapse with or without a treatment, or different times to relapse with different treatments, are useful information when it comes to deciding on treatment. But those curves which predict life expectancy as a function of prognostic indicators, or stage at diagnosis, serve no purpose except to make us crazy. They are, after all, statistics, nothing more.

What I'm saying is that if presenting such a curve has a useful purpose, by all means. But if it does not, if it has no impact on TX and is nothing more that a, say, life expectancy, why show it?

2. In this connection, much was said about prognostics (CD38, ZAP70, Q(11,17), mutational status, etc.). Dr. Kipps talked about this at length, and even assigned some life expectancies to the various combinations of prognostics.

Dr. Rai's opinion was slightly different, he seemed to place less emphasis on prognostics, and implied that the jury is still out on their relevance. For example, if you have bad prognostics, do you rush to treatment even if you a asymptomatic?

My personal opinion is with Dr. Rai. I should have been dead long ago.

3. The issue of initial TX with Chlorambucil vs. Fludarabine came up again and again. One statistic given was an 86% remission rate vs. 57% with Fludara and Chlor, respectively. Yet some of us do very well on Chlorambucil. Most docs still go with Fludara + Rituxan and/or Cytoxan. Most agree that single agent therapy is out.

4. Rituxan, although not initially developed for CLL, was highly praised. Everything seems to work better if Rituxan is added to it during TX.

5. The issue of scanning was again on the table. The latest and greatest is PET/CT. I asked again whether you get less radiation in PET/CT than in CT alone; the answer was sometimes yes, sometimes the same, depending on the technician and what they want to see. Surprisingly, MRI was relegated to the back seat, and said to be most useful in examining specific parts of the body (brain, a joint, etc.)

6. I already mentioned Dr. Rai's emphasis on not treating without a good reason (physical symptoms, doubling time, etc.) No one has ever shown that early TX improves the situation in the long run.

7. On the subject of transplantation, auto transplants have not been shown to be very useful with CLL. Allo are sometimes helpful, but carry greater risk. In any case, they should be mini transplants, with less devastating radiation and chemo TX beforehand.

8. Transformation are a bigger risk than I had supposed The longer one has CLL, the greater the chances that a transformation will occur. We all have to watch for that, be aware of it, and treat it aggressively if it occurs. If successful, the transformation may be conquered, and one is left with the good old CLL.

9. Cytopenias are also risky. Watch for anemia (red cells), thrombocytopenia (platelets) and neutropenia (white count).

10. Finally, NHL is now the FOURTH most common cancer (after prostate and breast and colorectal). And growing!!

I'll post more if I remember anything else.