Two-Drug Combo May Help Hard-to-Treat Leukemia
Fludara Plus Campath May Have Advantages Over Standard CLL Treatment
"The study shows clear benefits of the combination of Campath and Fludara for relapsed refractory CLL patients," says Hildy Dillon, senior vice president of The Leukemia and Lymphoma Society in White Plains, N.Y.
"Relapsed/refractory or progressive CLL is difficult to control or keep in check, so these results are very encouraging," Dillon says in an email. "It adds another possibility to keep their disease under control and prolong survival."
There is a caveat. "It is not possible to predict in advance which patients will benefit from this combination," she says.
The next step is for people with progressive CLL to ask their oncologists about this combination and whether or not it is an appropriate alternative.
Braunschweig agrees that this combination treatment may have a role in treating CLL. He says that this combination must now be compared to the gold standard, which as of now is a triple combination of Fludara, cyclophosphamide, and Rituxan (rituximab). Cyclophosphamide is a chemotherapy drug. Rituxan is a biologic drug that targets abnormal white blood cells found in people with CLL.
In general, CLL treatment depends on whether or not a person has symptoms, Braunschweig says. Many people who are diagnosed with CLL have no symptoms and are diagnosed based on abnormal blood test results. Others may have general symptoms such as severe fatigue and bleeding.
"If CLL is asymptomatic [without symptoms] and their blood counts look good, we watch and wait," he says. "If someone has symptoms or is profoundly anemic or has low blood platelets, we start chemotherapy.
"Many combination treatments are showing effectiveness and probably the natural history of disease can be impacted, so that is the encouraging message," Braunschweig tells WebMD.
None of these treatments are cures, he says. Bone marrow and stem cell transplants can be curative.
"Because there are no curative therapies for CLL, it's always important to have other options," says Nicole Lamanna, MD, a leukemia specialist at Memorial Sloan-Kettering Cancer Center in New York City.
"Many people with CLL wind up cycling on and off chemotherapy when their disease recurs," says Lamanna, who was not involved in the study. "It is always good to have other combination or salvage regimes to use in this situation."
She tells WebMD that longer follow-up studies are needed, especially when it comes to risks. In addition, fludarabine alone was compared to the combination therapy in this study of people with recurrent or hard-to-treat CLL.
"Fludarabine alone is not usually given as a salvage therapy, so it makes sense that the combination was better," she says.