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Re: UK CLEAR trial

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Some types of lymphomas do respond to antibiotics. But yes

you are right the trial tests the hypothesis that early

cases of CLL might be driven by an infective agent.

In a message dated 20/05/2011 23:11:56 GMT Daylight Time,

Nick writes:

CLEAR: CLL Empirical Antibiotic Regimen - A phase II trial

of broad spectrum antibiotic therapy for early stage, non-

progressive chronic lymphocytic leukaemia without adverse

prognostic factors

This phase II trial is testing the use of antibiotics for

patients with chronic lymphocytic leukaemia who have

received no prior treatment. Patients will receive a short

but intensive course of antibiotics, to help control the

symptoms of their disease, early on. This national trial is

being run by Dr Devereux at King's College London.

Does anyone have any links to studies or research documents

explaining the rationale? Or other studies/trials in this

area that have been carried out.

My limited understanding is that the trial is effectively

investigating if infection drives CLL progression during the

earlier stages of the disease?..

Nick (UK)

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I still believe that Epstein-Barr virus is involved...

(infectious mononucleosis)

It certainly is a contender...

It is implicated in Richter's Transformation and

Burkitt's lymphomas and Hodgkin's

~chris

<snipped>

> My limited understanding is that the trial is effectively

> investigating if infection drives CLL progression during the

> earlier stages of the disease?..

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If EBV is involved in the pathogenesis of CLL, this trial

would do very little to control it. They plan to use a mix

of antibiotics. And antibiotics do not work on viral

infections - such as EBV infection or reactivation.

>

> I still believe that Epstein-Barr virus is involved...

> (infectious mononucleosis)

>

> It certainly is a contender...

>

> It is implicated in Richter's Transformation and

> Burkitt's lymphomas and Hodgkin's

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But only in a small percentage of Richter's and Hodgkin's

and not all Burkitt's

In a message dated 21/05/2011 writes:

I still believe that Epstein-Barr virus is involved...

(infectious mononucleosis)

It certainly is a contender...

It is implicated in Richter's Transformation and

Burkitt's lymphomas and Hodgkin's

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Thanks all for your input,

Larry your point raises a question for me; that the anti

biotics only protect against bacterial pathogens? Is

response to these infections the action that the trial is

attempting to shut down. Thus simulating the same effect

that could be studied with use of anti virals. As we don't

have effective broad spectrum anti virals, could this be why

the trial only uses antibiotics. Or am I barking up the

wrong tree?

Could this study also provide relevant information that may

assist in adding a suitable antibiotic alternative to IvIg

in the future, that is more cost effective. Or are we still

awaiting development of the antibiotic alternative?

> If EBV is involved in the pathogenesis of CLL, this trial

> would do very little to control it.

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Perhaps it has something to do with the fact that the

surface Ig on CLL cells often reacts with common bacterial

antigens.

In a message dated 21/05/2011 Nick writes:

Larry your point raises a question for me; that the anti

biotics only protect against bacterial pathogens? Is

response to these infections the action that the trial is

attempting to shut down. Thus simulating the same effect

that could be studied with use of anti virals. As we don't

have effective broad spectrum anti virals, could this be why

the trial only uses antibiotics. Or am I barking up the

wrong tree?

Could this study also provide relevant information that may

assist in adding a suitable antibiotic alternative to IvIg

in the future, that is more cost effective. Or are we still

awaiting development of the antibiotic alternative?

> If EBV is involved in the pathogenesis of CLL, this trial

> would do very little to control it.

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I'm aware that antibiotics don't work on viruses...

I was referring to EBV as a possible cause in a larger

context than the clinical trial mentioned.

~chris

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Thank you Dr Hamblin.

I see, so removing any chance of this reaction,

may effect CLL symptoms?

Regards

Nick

> Perhaps it has something to do with the fact that the

> surface Ig on CLL cells often reacts with common bacterial

> antigens.

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It seems a cheap trial that might help to understand how CLL

starts.

In a message dated 21/05/2011 Nick writes:

I see, so removing any chance of this reaction,

may effect CLL symptoms?

> Perhaps it has something to do with the fact that the

> surface Ig on CLL cells often reacts with common bacterial

> antigens.

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