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Could Having One CLL Treatment Approach Limit Future Options?

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Published on September 26, 2014

As new research develops, patients often wonder if taking one CLL treatment now will prevent them from taking another option in the future. Dr. David Maloney and Dr. John Pagel,  leading CLL researchers, discuss what approaches can limit therapy choices down the road and the importance of a long-term planning conversation between people with CLL and their doctors.

This program was sponsored by The Patient Empowerment Network, which received educational grants from AbbVie, Inc., Genentech and Gilead Sciences, Inc.

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Transcript | Could Having One CLL Treatment Approach Limit Future Options?

Please remember the opinions expressed on Patient Power are not necessarily the views of Seattle Cancer Care Alliance, its medical staff 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:

Okay, David, so people are hearing, so we understand now that in most, all cases, we don’t know yet, that CLL is knocked on its head and knocked back, but not out, unfortunately. And so, someone says, well, if I have this treatment now, will that preclude me from what’s next?

So, in sort of longer-term treatment plans, so how do you plan, so you’re not limiting future options?

Dr. Maloney:

Well, again, that’s a discussion you have to have with your doctor. There are, let me give you some guidelines, though. So, for example, if you take a really aggressive chemotherapy option, you can damage the bone marrow and not be able to take that option down the road. So FCR is pretty toxic to the bone marrow.

So it may be hard to get intensive chemotherapies after that, for example. Some of these drugs knock out all your T cells. Now, why would I be interested in that? Well, I’m interesting in harvesting your T cells and making a CAR T-cell or something down the road. So fludarabine (Fludara) is really toxic to T cells.

Alemtuzumab or Campath is the only drug I tell people not to get in under, except rare circumstances, personally. I don’t like to use it ,because it’ll take out your T cells for years to years to years to come, if not forever. And so that can limit things.

But for the most part, these treatments can be used, you know, fairly sequence non-dependent with those caveats. John, anything else?

Dr. Pagel:

No, I think it’s right. I think this, you know, comes in a little bit with experience, perhaps, and it’s different for every single patient. But I do think it’s important for you and your doctor to be thinking not just about this treatment but what treatment might look like a decade later for you. 

And for somebody a decade later, you know, is really, really, really important. And others, if you’re, you know, already, you know, in your 80s, that might be less important. So thinking about those things and talking about those things, I think, are very important.

Please remember the opinions expressed on Patient Power are not necessarily the views of Seattle Cancer Care Alliance, its medical staff 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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