By Darci Picoult
It began with a bump. The size of a pinhead. Innocuous. An innocuous little pinhead of a bump on my vulva. Given that my gynecologist said the bump was probably nothing, I laughed it off. Which, in turn, made my bump mad. Very mad. It wanted my attention. And so it grew. I smeared it in medicine. It grew more. More medicine. More growth. Hanukkah came. Then Christmas. A war raged between us. I went to battle in the middle of the night with salt baths and creams. Prayed for its departure...
Revised text to state that the surrogate endpoint of such clearance of residual disease, while prognostic, has not been shown to improve survival in a randomized prospective trial.
Revised text in the third treatment option to state that a trial of 138 patients, who were previously treated with fludarabine and alemtuzumab, showed overall response rates around 50% in patients refractory to fludarabine and with prior exposure to rituximab (cited Wierda et al. as reference 14).
Added text to include lenalidomide as a treatment option and stated that it is an oral immunomodulatory agent with response rates over 50% for patients with previously treated and untreated disease (cited Chen et al., Chanan-Khan et al., and Ferrajoli et al. as references 34, 35, and 36, respectively, and Badoux et al. as reference 37 and level of evidence 3iiiDiv). Also added that prolonged, lower-dose approaches and attention to prevention of tumor lysis syndrome are recommended with this agent (cited Moutouh-de Parseval et al. as reference 38). Combination therapy and long-term toxicities from using lenalidomide remain undefined for patients with chronic lymphocytic leukemia.
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September 04, 2014
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