|
Terry Hamblin |
Most patients with CLL
cannot be cured by current therapy. This means that
patients have to learn to live with their disease. For
most people, the biggest
problem is impaired immunity. Unfortunately all
effective treatment for CLL
makes the immune deficiency worse. This means that for
most patients giving
the immune system a helping hand is very important. How
to do this is by no
means worked out.
What has been shown to be of benefit in controlled
trials is three-weekly
infusions of immunoglobulin in patients with serum IgG
of <3g/L and more than
one bacterial infection in a six month period. There is
no published evidence
that patients with less severe hypogammaglobulinemia
benefit from intravenous
immunoglobulin.
It is also known that patients with neutrophil levels
less tha 500/cu mm are
prone to bacterial infections and that G-CSF will
reproducibly raise the
neutrophil count.
These proven benefits fall far short of giving CLL
patients the support they
need against infections. We are therefore very much in
need of clinical
trials designed to test whether CLL patients will
benefit from a host of
potential remedies for immunodeficincies. These include
vaccines, antibiotics, white
cell growth factors, antivirals, antifungals, and T-cell
stimulants.
I happen to think that trials directed at this problem
would benefit
patients more than trials designed to slightly increase
the complete remission rate
or extemd the progression free survival by a few months.
If we had prospects
of cure, things might be different, but as things stand
even patients who
have remissions lasting many years do not restore their
immune systems to normal.
|
|
Terry Hamblin |
Patients with CLL are very
poor at making immune responses especially to
polysaccharide antigens that are found in many bacteria
such as pneumococcus, haemophilus, staphylococcus and
streptococcus. These are just the sort of bacteria that
infect the ear and sinuses.
If your serum immunoglobulins are less than 3g/L then
you might benefit from IvIg, but otherwise long term
antibiotics may be necessary. |
