Treatment with Cisplatin-Based Chemotherapy Yields High Risk of Mortality Unrelated to Disease in Testicular Cancer

What Is Chronic Lymphocytic Leukemia?

Chronic lymphocytic leukemia-- or CLL-- is a type of cancer that happens in your blood and bone marrow, the spongy tissue inside your bones. While the exact cause isn't known, doctors do know that something happens to change the genetic code inside your cells that make white blood cells.

Normally, these cells help your body fight infection, but because of the change-- called a mutation-- faulty white blood cells that don't work like they should are made instead. These damaged blood cells build up in your bone marrow, crowding out healthy cells, and keeping new blood cells from being made. As they continue to grow, they can spread to your blood and build up in your organs.

CLL gets worse slowly, and many people don't have symptoms at first. Over time, you could have swollen lymph nodes, a fever, a tired feeling, belly pain, night sweats, weight loss, or more frequent infections. You're more likely to get CLL if you're middle-aged or older, have been around certain chemicals, or if a family member has had blood or bone cancer.

To see if you have chronic lymphocytic leukemia, your doctor will run some tests on your blood, bone marrow, and lymph nodes. If your CLL is in the early stages, you may not need treatment right away. If you do, your treatment will depend on your cancer stage, symptoms, total health, and preferences. Treatment options can include chemotherapy, targeted drugs, immunotherapy, and bone marrow transplant.

For more information about chronic lymphocytic leukemia, talk to your doctor. [MUSIC PLAYING] ","publisher":"WebMD Video"} ]]>

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SPEAKER

Chronic lymphocytic leukemia-- or CLL-- is a type of cancer that happens in your blood and bone marrow, the spongy tissue inside your bones. While the exact cause isn't known, doctors do know that something happens to change the genetic code inside your cells that make white blood cells.

Normally, these cells help your body fight infection, but because of the change-- called a mutation-- faulty white blood cells that don't work like they should are made instead. These damaged blood cells build up in your bone marrow, crowding out healthy cells, and keeping new blood cells from being made. As they continue to grow, they can spread to your blood and build up in your organs.

CLL gets worse slowly, and many people don't have symptoms at first. Over time, you could have swollen lymph nodes, a fever, a tired feeling, belly pain, night sweats, weight loss, or more frequent infections. You're more likely to get CLL if you're middle-aged or older, have been around certain chemicals, or if a family member has had blood or bone cancer.

To see if you have chronic lymphocytic leukemia, your doctor will run some tests on your blood, bone marrow, and lymph nodes. If your CLL is in the early stages, you may not need treatment right away. If you do, your treatment will depend on your cancer stage, symptoms, total health, and preferences. Treatment options can include chemotherapy, targeted drugs, immunotherapy, and bone marrow transplant.

For more information about chronic lymphocytic leukemia, talk to your doctor. [MUSIC PLAYING]

Newer Therapies For Acute Lymphoblastic Leukemia May Reduce Side Effects

New treatments for acute lymphoblastic leukemia may lead to fewer side effects than chemotherapy, as they target cancer cells more precisely, an expert said.

Newer treatments for patients with acute lymphoblastic leukemia may offer the potential for fewer side effects than traditional chemotherapy, an expert said.

These innovative therapies, including drugs like Besponsa (inotuzumab), glembatumumab and Blincyto (blinatumomab), target cancer cells more precisely, reducing the impact on healthy cells. This can lead to fewer side effects such as low blood cell counts and liver problems, which are common with chemotherapy.

Glossary:

Cytokine release syndrome: a large, rapid release of cytokines from immune cells into the blood that may result from immunotherapy. Symptoms may include nausea, fever, rash, headache, low blood pressure, rapid heartbeat and trouble breathing.

Immune effector cell-associated neurotoxicity syndrome: a neurological condition when the immune system causes inflammation in the brain, which may lead to mild to severe symptoms affecting movement, cognitive functions and speech.

Cytopenia: lower than normal number of blood cells.

Transaminitis: elevated levels of transaminases, a liver enzyme, in the blood, which may indicate liver damage.

Vaso-occlusive disease: when blood vessels become blocked by clumping of red blood cells, which can prevent blood flow to certain areas of the body.

Hyper-CVAD: a chemotherapy regimen used to treat some types of lymphoma and leukemia.

Febrile complications: issues that can occur as a result of a fever. 

At the 43rd Annual Chemotherapy Foundation Symposium, CURE® spoke with Dr. Hannah Levavi to learn more about these new treatments. Particularly, we discussed how these newer treatments compare with chemotherapy regarding side effects, and how to best optimize treatment plans.

Levavi is an assistant professor of medicine, hematology and medical oncology at The Tisch Cancer Institute at Mount Sinai Hospital in New York.

Transcript:

So one real benefit of the novel therapies is that they're much more tolerable, especially in an older population, than traditional chemotherapy. So while both inotuzumab (Besponsa) and glembatumumab do have toxicities, blinatumomab (Blincyto) has CRS (cytokine release syndrome) and ICANS (immune effector cell-associated neurotoxicity syndrome), as well as some degree of cytopenias and transaminitis. And inotuzumab, of course, has a risk of transaminitis as well as vaso-occlusive disease. These side effects are much more tolerable for most patients than traditional chemotherapy, especially when comparing these to very common chemotherapy backbones that are used in the community, like Hyper-CVAD, so patients don't develop the same degree of cytopenias. They don't develop the same degree of febrile complications. So these are really very tolerable.

There — and as we work through these therapies, we're learning more about how to refine the way we dose them and the way we manage the adverse events in order to mitigate some of these toxicities, such as reducing the dose and fractionating inotuzumab.

For more news on cancer updates, research and education, don't forget to subscribe to CURE®'s newsletters here.

FDA Approves Revuforj For Relapsed/Refractory Acute Leukemia Subset

Revuforj was approved by the FDA for adults and children with relapsed/refractory acute leukemia with a KMT2A translocation.

The FDA approved Revuforj (revumenib) for adults and children with relapsed or refractory acute leukemia with a KMT2A translocation.

The Food and Drug Administration (FDA) approved Revuforj (revumenib) for the treatment of adults and children aged 1 year and older with relapsed or refractory acute leukemia with a KMT2A translocation.

Of note, translocation refers to a genetic change when a piece of chromosome breaks off and then attaches to another chromosome.

The approval, which was announced in a notice from the FDA, was based on findings from the AUGMENT-101 trial including 104 adult and pediatric patients with relapsed or refractory acute leukemia with a KMT2A translocation. Notably, patients with an 11q23 partial tandem duplication were excluded. A partial tandem duplication is when a segment of DNA is duplicated and inserted next to the original sequence, which can disrupt normal cellular processes.

Patients in the AUGMENT-101 trial were treated with Revuforj until unacceptable toxicity, disease progression, hematopoietic stem cell transplantation or failure to achieve morphological leukemia-free state by four cycles of treatment, according to the notice. Morphological leukemia-free state is when a patient with leukemia no longer exhibits any abnormal blood cells or bone marrow cells characteristic of the disease.

Glossary:

Increased aspartate aminotransferase: an enzyme that may indicate damage to the heart, liver, muscle or kidney. 

Febrile neutropenia: fever and lower-than-normal number of neutrophils in the blood.

Increased intact parathyroid hormone: when the parathyroid glands produce too much parathyroid hormone, which play a role in regulating phosphorus and calcium levels in the blood.

Increased alanine aminotransferase: an enzyme that, when increased, may indicate liver damage.

QT prolongation: a longer time for the ventricles of the heart to contract and relax.

Differentiation syndrome: a large, rapid release of cytokines from leukemia cells.

Increased triglycerides: high levels of fat that the body uses for energy and can be found in oils, butter and other fats.

The main areas of interest in the trial were complete remission plus complete remission with partial hematological recovery, conversion from transfusion dependence to independence and duration of complete remission plus complete remission with partial hematological recovery, which is when all signs of leukemia have disappeared, although the patient's blood cell counts have not fully recovered.

Of the patients in the AUGMENT-101 trial, 21.2% achieved complete remission plus complete remission with partial hematological recovery with a median duration of 6.4 months. In addition, of the 22 patients who achieved either complete response or complete remission with partial hematological recovery, the median time to either of those outcomes was 1.9 months.

Trial findings also demonstrated that of the 83 patients who were dependent on red blood cell and/or platelet transfusions at the start of the trial, 14% because independent of red blood cell and platelet transfusions during the 56-day period after the start of the trial, according to the notice. In addition, of the 21 patients who were independent of both red blood cell and platelet transfusions at the start of the study, 48% remained independent of transfusions during this time period after the start of the study.

The most common side effects, which occurred in at least 20% of patients, included nausea, bleeding, musculoskeletal pain, high phosphate levels, increased aspartate aminotransferase, infection, febrile neutropenia, increased intact parathyroid hormone, increased alanine aminotransferase, diarrhea, bacterial infection, QT prolongation, differentiation syndrome, increased triglycerides, decreased phosphate, decreased potassium, constipation, decreased appetite, fatigue, viral infection and increased alkaline phosphatase.

The FDA noted that the recommended dose of Revuforj can vary based on a patient's weight and simultaneous use of CPT3A4 inhibitors. In addition, there is an anticipated delay in commercial availability of the lowest-dose strength of Revuforj, for use in patients who weigh less than 40 kilograms. Because of this, Revuforj will be available via an expanded access program to allow for dosing for those specific patients.

For more news on cancer updates, research and education, don't forget to subscribe to CURE®'s newsletters here.

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