CLL Treatments
The eminent British CLL specialist Dr. Terry Hamblin has provided in a recent blog entry an excellent list of the side effects of the various drugs currently being used to treat this form of leukemia.--- http://mutated-unmuated.blogspot.com/2009/01/side-effects.html
I have met Dr. Hamblin. In fact when I was living in Europe I went over to meet him in England so that he could do prognostic testing on me. He is one of the most respected researchers in the entire world on CLL. He also is a really nice guy who is funny, and a gentleman who it is a real pleasure to spend some time with.
He is able to speak doctor-talk, and also at times can communicate using language that the laity understands. Unfortunately this paper of his describing the side effects of CLL medications is not written in a language that normal well educated patients can understand.
If I were sitting down with Dr. Hamblin to chat and drink a cup of tea here is what I would like to ask him:
(1) Is there verifiable statistical proof which shows that using any of these various toxic treatments measurably increases the life span of CLL patients?
(2) One of the biggest problems with this particular form of leukemia is that it gradually lowers the ability of the body to fight off disease. Over time the immune system gets more and more suppressed. Most of the current chemotherapy treatments reduce even further the proper functioning of the body’s immune system.
So I would like to ask Dr. Hamblin if any of the currently used “treatments” for CLL are proven to significantly increase life span, and at the same time do not reduce the proper functioning of the body’s immune system? Maybe actually make the immune system work even better?
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I am afraid that his reversion to doctor-speak in this article is a camouflage for this basic dilemma.
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Dr. Hamblin was kind enough to respond:
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Hi Paul,
You are right that there has never been a controlled trial comparing any treatment with no treatment, but there is no doubt at all that when patients get very ill with CLL and would die untreated within a matter of weeks, it is sometimes possible to rescue them with chemotherapy, and after that they sometimes live for a very long time.
It is also true that when patients have severe symptoms from CLL, it is usually possible to relieve them with treatment.
What has not been shown in any trial is that using anything other than chlorambucil as first line, extends overall survival.
There are studies that show that people are living longer with CLL than they used to, and part of that increased survival may be due to the fact that we have more and possibly more effective drugs now, but there are other explanations: better supportive care; earlier diagnosis; changes in the definition of CLL etc.
You are also right to say that all treatments of CLL make the immunodeficiency worse, but whether this is a big issue depends very much on the individual patient. For those who start out with a very poor immune system, it obviously is a very important factor, but for other patients, even a big hit on their immune system leaves them better off than are some patients before they start treatment.
That's why treatment is a matter of judgement requiring an experienced physician. You can't do it by applying a formula.
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