tidbits header CLL Global logo .

Bits and Pieces from the CLL Global Community   

QUICK LINKS

 

 

More About Us

 

Tidbits Archives

BE SOCIAL

 

 __________________

  

Find us on Facebook

 Join our Cause

 

 __________________

   

Find us on Facebook

 

NEWLY DIAGNOSED

If you have recently been diagnosed with CLL, you probably have questions. 

  

Information about CLL

 

What we are doing to defeat CLL

 

List of CLL specialists around the world

(Provided by ACOR) 

 

FEATURED VIDEO

Dr. Michael Keating was the key-note speaker at the CLL Live Conference recently held in Canada. Here he discusses new treatment and research strategies.    

Keating video     

FUNDED PROJECTS

 Click on the links to read about projects  from the CLL-Stromal Interaction Group, part of the CLL Global Alliance. This group is investigating the  microenvironments of CLL and the relationships CLL cells have with other cells in the body.   

 
 Dr. Federico Caligaris-Cappio
Instituto Scientifico San Raffaele (Italy)
Dissecting the molecular pathways involved in the interactions between microenvironment and CLL cells


Dr. Nicholas Chiorazzi
Feinstein Institute for Medical Research
Dr. Chiorazzi collaborates with members of the CLL-Stromal Interaction group and carries out research related to this field. 


Dr. Zeev Estrov
UT MD Anderson Cancer Center 

FATHER'S DAY IS  

JUNE 18TH 

Show Dad you love him with a donation to CLL Global.

If you are a dad, ask your family to make a donation in your honor.
 

We will create an acknowledgement card for the occasion. Make sure to indicate your donation is in honor of Father's Day on the donation form. If you make a donation through JustGive.org, email us at [email protected] so we can send the acknowledgement card in a timely fashion.

QUESTIONS/COMMENTS?

Is there something specific you want to read and learn about? 

 

Let us know if you have any comments or suggestions for improvement.

 

You are the reason CLL Global exists, and we want to hear from you.

 

[email protected]

DONATE NOW!! 

donate button  

 

 

May 2012 

Greetings!

 

Thanks for joining us for another issue of Tidbits. Dr. Keating is ambitious to get rid of chemotherapy. This month he takes us on a magical mystery tour of new, non-chemotherapeutic strategies. We also clarify what the microenvironment is and its relation to the success of non-chemotherapies. The series on clinical trials continues with the ins and outs of Phase II trials.        

PRESIDENT'S CORNER: opinions & reports from Dr. Keating

Getting Rid of Chemotherapy in CLL:   

a magical mystery tour 

Dr. Michael Keating
Dr. Michael Keating
President and CEO  of CLL Global

My experience with CLL has been a trip of a lifetime. I have been optimistic about eradicating this disease since day one, and former skeptics are finally jumping on board. So come with me now for the magical mystery tour of CLL and learn how we are changing the way patients are treated.    

 

Chemotherapy has played a pivotal role in cancer treatment for many decades. My mentor, Dr. Emil J Freireich, led the first clinical trials using multiple types of chemotherapy as treatment in the 1960s. The success of these experiments led to the cure for 80-90% of patients suffering from childhood acute lymphoblastic leukemia, opening the door to combination chemotherapy as a standard option for most cancers.

 

Twelve years ago, we combined two chemotherapy drugs, fludarabine (Fludara) and cyclophosphamide (Cytoxan), with the monoclonal antibody, rituximab (Rituxan). This combination, known as FCR, changed the way CLL is treated and has had a significant impact for CLL patients. It has become the standard treatment option for patients who can tolerate it, and has been described as "the gold standard for CLL". While this sounds good, concerns have persisted.

 

Fludarabine and cyclophosphamide, and all chemotherapies, cause suppression of the immune system, a depression in normal blood counts and DNA damage which may contribute to the causation of second cancers. Additionally, FCR and other current treatments are not benefiting every CLL patient. Thus, a major goal regarding treatment is to replace chemotherapeutic agents with more personalized options. 

 

The anti-chemotherapy era in which we are about to embark has been decades in the making. One of the biggest challenges to date with treating CLL is that it has a very comfortable relationship with other cells in the body and the immune system. Even though CLL is an invader, the body thinks it is not. CLL cells manipulate other cells in order to stay alive and thrive. Previously, researchers could not figure out why some drugs worked well when tested in a petri dish in the laboratory, but were significantly less effective once given to patients. Once this mystery was partially solved, the playing field changed.


Click here to continue reading the article.

 

CLL EDUCATION

 

The CLL Microenvironment

 

A microenvironment is a habitat in the body made up of a structural network of cells within individual organs. Teamwork and communication between cells in the microenvironment allow the cells and organs to survive. CLL cells reside in a few microenvironments within the body: the lymph nodes, spleen and bone marrow. These microenvironments provide protective surroundings for the CLL cells to dwell which makes this an optimal area to target with therapy.

 

Researchers have known for many years that CLL cells infiltrate the lymph nodes, spleen and bone marrow. However, it was not until recently that a working concept of the microenvironment was suggested. Researchers were previously perplexed that drugs were successful at eliminating CLL cells when tested in the laboratory, but not as successful when given to patients. Also, CLL cells are notorious for resisting cell death (called apoptosis) which is a normal part of the cell cycle. But, researchers could not figure out why CLL cells would die so quickly when taken out of a patient's body for research. The extent to which CLL cells rely on other cells in the body is now understood.

 

CLL microenvironment
This image is a model of the bone marrow microenvironment. Here the CLL cells (in green) interact with the stromal cells (in red).
   

CLL cells are known for freely floating throughout the blood

stream. It is now thought that the microenvironments may serve as "refueling" stations. One hypothesis is that CLL cells travel around the body and dock in a lymphatic tissue to reenergize. The CLL microenvironments consist of populations of different types of cells. Some of the major players are stromal cells which make up the connective tissue, accessory cells that aid in communication, nurselike cells that attract CLL cells to the microenvironment and protect them from apoptosis, and T-cells which promote growth and drug resistance.

 

The discovery of the microenvironment has had a large impact on CLL treatment. As discussed in the President's Corner article above, new drugs like ibrutinib (formerly PCI-32765) and lenalidomide (Revlimid) are already being used to target the communication between CLL cells and their microenvironments. The full effectiveness of these drugs is to be determined. In the interim, researchers will continue to unveil the connection between CLL cells and the protection provided by the microenvironment to consider new ways to exploit this relationship.  

 

CLINICAL TRIALS AND YOU 

 

Phase II Clinical Trials

 

Last month's issue of Tidbits introduced Phase I trials as studies conducted to ensure a new drug or treatment is safe in humans and to determine the optimal dosage. (Click here to read the article.) The optimal dose is then used in Phase II trials which look at a drug's efficacy in people with a specific type of cancer or related cancer. Phase II studies relevant for CLL patients may incorporate other hematologic malignancies such as B-cell Non-Hodgkin Lymphoma and Waldenstrom's Macroglobulinemia. Another important objective of Phase II studies is to continue to look at the safety of the treatment.

 

Phase II trials enroll more patients than Phase I studies and are often conducted at more institutions. In general, Phase II studies usually have less than 100 participants. Having a larger cohort of patients gives researchers a better idea of potential side effects and may expose some less common side effects. clinical trials humor

Regardless of the phase of study, all clinical trials are subject to an extensive review of safety. An Institutional Review Board can stop a trial at any time if patients are experiencing unexpected harm. During clinical trials, there is a constant evaluation of the risk-benefit ratio.

 

Depending on the particular Phase II study, patients may or may not be able to receive prior treatment for their disease. The eligibility criteria for the protocol of the study details whether or not prior treatments are acceptable and if so, what type and amount of prior treatments are permitted.

 

Phase II trials are intended to provide an indication as to whether a treatment is effective. After a Phase I or Phase II trial, the researchers may decide not to move on to the next phase of development or to stop testing if the treatment is not safe or effective. Sometimes clinical trial phases may be combined (for example Phase I/II or Phase II/III trials). In this case the goal may be to allow for quicker development of a new treatment. Next month's Tidbits will explore Phase III trials.

 

THANK YOU FOR SUPPORTING US!



CLL Global wishes all of the moms a Happy Mother's Day! Remember that Father's Day is next month, and a donation to CLL Global is a wonderful way to show you care. Until next time, be happy and well.

   

Sincerely,


CLL Global Research Foundation