ONCAlert | 2017 San Antonio Breast Cancer Symposium
Chronic Lymphocytic Leukemia Case Studies

Paul Barr, MD: Bendamustine/Rituximab Therapy

Paul Barr, MD
Published Online:Nov 02, 2015
James S is a 67-year old college professor from Ithaca, New York with a history of treatment for Agent Orange exposure

Relapsed and Refractory CLL with Javier Pinilla-lbarz, MD, PhD and Paul Barr, MD: Case 2

Relapsed and Refractory CLL with Javier Pinilla-lbarz, MD, PhD and Paul Barr, MD: Case 1
Relapsed and Refractory CLL with Javier Pinilla-lbarz, MD, PhD and Paul Barr, MD: Case 2
Relapsed and Refractory CLL with Javier Pinilla-lbarz, MD, PhD and Paul Barr, MD: Case 1
Relapsed and Refractory CLL with Javier Pinilla-lbarz, MD, PhD and Paul Barr, MD: Case 2
Relapsed and Refractory CLL with Javier Pinilla-lbarz, MD, PhD and Paul Barr, MD: Case 1
Relapsed and Refractory CLL with Javier Pinilla-lbarz, MD, PhD and Paul Barr, MD: Case 2

 

Would you consider retreatment with bendamustine/rituximab (BR) therapy in this patient?

 

I would not consider another course of bendamustine/rituximab for such a patient. That strategy of repeating the same therapy that someone received before came from a time when we had fewer treatment options and was useful in patients who had a very long duration of remission. So, say someone received bendamustine/rituximab and was in remission for 10 years or so. It’s not a bad idea to think about retreatment in a case like that. But for such a patient we are interpreting his duration of remission as being very short, being only a year. We would expect a second course to result in a duration of remission only measured in a few months. So to endure the toxicities of another course of chemoimmunotherapy for very little benefit just doesn’t seem like a good option for this patient.

Case 2: Relapsed and Refractory CLL

James S. is a 67-year-old college professor from Ithaca, New York; he is a Vietnam veteran with a history of treatment for Agent Orange exposure; his history is also notable for prior smoking (15-pack year) and mild COPD.

  • In November 2013, he presented to his PCP for a routine physical; his examination showed mild lymphadenopathy and his CBC showed evidence of lymphocytosis (lymphocytes 6 x 109/L); he was referred to an oncologist for further diagnostic evaluation.

  • Differential diagnosis showed B-cell CLL, with absolute lymphocytosis (19,000/mm3) and flow cytometry positive for CD5 and CD23.

  • Interphase cytogenetic analysis showed no deletion of 17p.

  • The oncologist initiates treatment with bendamustine/rituximab (BR) and James shows improvement in hematologic parameters after 6 cycles.

  • James was out of the country at a meeting, and he failed to return for a scheduled follow-up appointment in January 2015.

In March 2015, he presented to his oncologist with symptoms of unintentional weight loss over the past 2 months (>10%), severe fatigue (interfering with work), and dyspnea; his CBC is consistent with worsening anemia and thrombocytopenia.

  • CT scan shows evidence of extensive abdominal lymph node recurrence.

  • At the time of his recurrence, James’s ECOG performance status was 2, and liver and kidney functioning were within normal limits.

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