Combination therapy promises chronic lymphocytic leukemia

Bone marrow aspiration smear stained with Wright patients with acute lymphoblastic leukemia with prodromal B-cells. Credits: VashiDonsk / Wikimedia / CC BY-SA 3.0

The combination of small molecule inhibitors and monoclonal antibody immunotherapy improved the outcomes of patients with recurrent chronic lymphocytic leukemia (CLL), according to a Northwestern Medicine clinical trial published in. blood..

He is an associate professor of medicine at the Department of Hematology and Oncology and researches.

CLL is the most common type of leukemia in the elderly, where B lymphocytes, a type of white blood cell, develop into cancer cells in the bone marrow, blood and lymphatic system. Patients usually do not feel symptoms at the time of initial diagnosis, but over time cancer cells can multiply and cause symptoms and disorders of bone marrow function and require treatment.

Traditional chemoimmunotherapy has been the standard treatment choice, but in recent years treatment strategies have been primarily a small molecule inhibitor that targets enzymes in the B cell receptor signaling or apoptotic pathways (BCRs). BCR pathway inhibitors prevent the growth and growth of cancer cells by blocking communication between leukemia cells and the tumor microenvironment.

“These inhibitors require continuous and unrestricted treatment,” said Ma, who is also a member of the Robert H. Lully Cancer Center at Northwestern University.

Other classes of targeted therapies, such as venetoclax, target the protective protein BCL2 and induce rapid tumor death by programmed cell death.

Previous paper Edition NS Oncology LancetMa, who is also one of the lead authors, reported that a phase 1b trial of a new combination of venetoclax and monoclonal antibody immunotherapy called rituximab would be very effective in patients with reversible or refractory CLL.

In this study, patients received 200-600 milligrams of venetoclax and rituximab daily for 6 months, followed by venetoclax monotherapy. Rituximab, which targets the CD20 molecule expressed on the surface of B cells, is widely used today in combination with chemotherapy and other targeted therapies for various types of B cell lymphoma and leukemia, including CLL.

Ma et al found that the combination of venetoclax and rituximab was very effective in rapidly reducing the burden of leukemia, with most patients achieving a deep response with minimal residual lesions. Shown. Patients with a profound response to venetoclax-rituximab treatment may also have chosen to continue venetoclax alone or discontinue treatment altogether.

In the current follow-up report, Ma and colleagues evaluated a five-year patient outcome of combination therapy with venetoclax and rituximab. Patients after 5 years had an overall survival, progression-free survival, and duration of treatment response of 86%, 56%, and 58%, respectively. In addition, 74% of patients in combination therapy, according to the authors, those who chose to discontinue treatment had permanent remission, similar to those who chose to continue treatment.

According to Ma, the findings support certain Venetoclax-based treatments that are currently the standard of care.

“We also reported the efficacy of venetoclax-rituximab re-treatment in patients who progressed after completion of the initial course of treatment, further expanding the clinical benefits of the venetoclax base. Treatment “The horse added.

Combination targeted therapy allows for permanent remission in patients with CLL

For more information:
Shuo Ma et al., Efficacy of Venetoclax and Rituximab for recurrent CLL: 5-year follow-up of continuous or limited treatment time, blood (2021). DOI: 10.1182 / blood.2020009578

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Northwestern University

Quote: Combination therapy for chronic lymphocytic leukemia (August 2021) obtained from August 2, 2021. 2 days) shows the possibility

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Combination therapy promises for chronic lymphocytic leukemia Original link Combination therapy promises for chronic lymphocytic leukemia

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