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How Do Autoimmune Diseases Affect CLL?

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Published on September 1, 2016

In this “Ask the Expert” segment, Dr. Nicole Lamanna, a CLL specialist at Columbia University Medical Center, answers a question about treatment options for CLL patients with autoimmune diseases.  Using the “chicken-and-egg” analysis, she describes various autoimmune diseases and treatments viable for CLL patients.  Dr. Lamanna stresses that autoimmune specialists and CLL specialist should be communicating to ensure the best care.

Sponsored through an educational grant from the Patient Empowerment Network, which received support from AbbVie Inc. and Genentech Inc.

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Transcript | How Do Autoimmune Diseases Affect CLL?

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

Andrew Schorr:

Here's a question we got from another viewer.  How do autoimmune diseases like rheumatoid arthritis or Hashimoto's, others like that, affect CLL and the way you treat it?  

Dr. Lamanna:

Yeah. So very, very good question.  So there's no doubt, maybe it's underappreciated or now becoming more appreciated, that other autoimmune diseases—and again, we don't know the chicken or the egg. I like to think of CLL as a disorder of your immune system in general. So is it that the CLL predisposes people to other autoimmune issues, or is it a fact that their immune system was already awry to begin with and they have more than one problem, CLL and other complications?

And so they do play a role with each other depending upon what's driving the ship.  And so for patients who develop autoimmune blood disorders that are related to your CLL, we may actually choose treatment options that might be more driven toward your immune problem.  For people who might have rheumatoid arthritis or multiple sclerosis, believe it or not, some of the drugs that we use for CLL like the monoclonal antibodies such as rituximab (Rituxan) can actually be used for your autoimmune problem.  

So it depends on what needs to be treated or what your physician is dealing with.  Is it the primary autoimmune process, the CLL or both, then usually actually we might pair therapies to actually treat both.  So they do have an impact, and there's no doubt we flares in people's autoimmune issues, irritable bowel, celiac disease, Crohn's that may have to—if we don't think that whatever their other physician who might be treating their autoimmune problem is working, sometimes we have to pair a CLL therapy and antibody, some steroids or other to kind of calm the whole process down, so they definitely influence each other. 

Andrew Schorr:

So it sounds like if somebody has an autoimmune condition and CLL…

Dr. Lamanna:

Yeah. A CLL doctor…

Andrew Schorr:

…you need to get your doctors… 

Dr. Lamanna:

You got it. 

Andrew Schorr:

…talking. 

Dr. Lamanna:

Absolutely correct. And sometimes, I mean—you know, again, it depends on the comfort levels of the physicians. I'll tend to drive that in my practice because I know there's a linkage between the—these processes, but if not and you have a rheumatoid, absolutely they need to talk. And that usually works pretty well.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

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