Thousands of leukemia patients could be spared chemotherapy thanks to a new two-in-one treatment that has been found to keep twice as many patients free of the disease. The drugs also cause fewer side effects, meaning patients can continue their lives normally.
Chronic lymphocytic leukemia, known as CLL, attacks white blood cells, breaks down the body’s ability to fight infection, and is rarely completely cured. Instead, patients live with the cancer and undergo treatment to keep it under control for as long as possible.
Because the disease develops slowly, doctors have to wait until there is enough cancer in the blood to warrant aggressive treatment.
While patients can be declared cancer-free after chemotherapy, the leukemia eventually returns and more rounds are needed.
Thousands of leukemia patients can be saved from chemotherapy thanks to a new two-in-one treatment that has been found to keep twice as many patients free from the disease
Usually, an initial period of cancer-free remission lasts three years, but each time chemotherapy is used, it becomes less effective.
About 70 percent of patients survive with the disease for five years or more. However, the chance decreases the longer a patient has it and the older they are. About 3,700 people in the UK are diagnosed with CLL each year, with 1,000 deaths.
The recently approved combination of the drugs venetoclax and obinutuzumab, which was approved earlier this month by regulators at the National Institute for Health and Care Excellence, allows patients to opt out of chemotherapy altogether.
Professor Peter Hillmen, clinical hematology advisor at the Leeds Teaching Hospitals NHS Trust, says the drug will have a ‘life-changing effect for all CLL patients’. He adds, “Every patient is now receiving a modern therapy that not only avoids chemotherapy, but also improves their chances of survival – it’s a big step forward.”
White blood cells are the immune system’s main defense against infection. They develop in the bone marrow – the spongy material in bones – and are then sent into the bloodstream.
CLL occurs when the bone marrow starts to make abnormal white blood cells called lymphocytes that are not fully developed and therefore cannot protect the body.
Chronic lymphocytic leukemia, known as CLL, attacks white blood cells, breaks down the body’s ability to fight infection, and is rarely completely cured (photo file)
When too many of these abnormal cells are in circulation, they crowd out the functioning cells and the immune system can’t fight even minor infections.
The abnormal lymphocytes can build up in lymph nodes – glands in the neck, under the arms, and in the groin that are a vital part of the immune system – leading to swelling. But often it goes unnoticed until the lymphocytes reach dangerous levels and the immune system is compromised.
With chemotherapy, patients may experience side effects such as nausea, persistent fatigue and hair loss. While the new CLL treatment isn’t without its risks – its side effects include nausea, diarrhea and, rarely, liver failure – studies have shown that patients tolerate it better.
Daily venetoclax tablets are given in addition to occasional intravenous infusions of obinutuzumab.
Venetoclax works by limiting the production of a type of protein that cancer cells need to survive, while obinutuzumab helps the immune system detect and kill abnormal cells. A study of the effectiveness of the combination found that 81 percent of the subjects went into remission for at least three years, compared with 49 percent of the patients who received chemotherapy.
With chemotherapy, patients may experience side effects such as nausea, persistent fatigue and hair loss (photo file)
John Shaw, a 70-year-old test subject from Leeds, was accidentally diagnosed with CLL almost a decade ago. He had gone to hospital after getting chest pain while chopping wood. It turned out to be just a muscle strain, but a blood test revealed abnormal cells in his immune system. He said, ‘I had never heard of CLL until that night. You just hear the word leukemia and think, “I’m dead.” ‘
Five years later, John’s doctor told him that the disease had progressed to the point where it was time for treatment. He was referred to Prof. Hillmen and took part in the drug trial.
In just under two years, the concentration of abnormal cells in John’s body dropped from 70 percent to 0.2 percent. He said, “Every time I left the hospital I felt like clicking my heels, I was so happy.”
In November 2017, treatment was discontinued and John’s abnormal cell count has remained low ever since.
Professor Hillmen says it is unlikely that John’s cancer will rise to dangerous levels again in the next decade. And if it does, he’ll be able to combat it with another round of the combination treatment. He said, ‘Patients can spend years with and without chemo, greatly affecting their lifestyle, only for the cancer to eventually kill them.
“This therapy extends patients’ lives, but also allows them to pursue a relatively normal lifestyle – they can maintain hobbies and stay active.”
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