“The future is full healing and maintaining a quality of life”: the new treatments


Chronic lymphocytic leukemia (CLL) is the most common leukemia in the Western world. In Israel, about 500 CLL patients are diagnosed each year. The average age at diagnosis is 70, and it is more common among Jewish men of Ashkenazi descent. Since 2020, there has been a real revolution in terms of CLL treatment. Chemotherapy treatment gives way to biological therapies, which allow a significant improvement in the patients’ quality of life and in some cases even cessation of treatment and remission from the disease. Dr. Yafit Segman from Assuta Hospital in Ashdod explains the changes that have taken place in the treatment of the disease, and answers frequently asked questions.

“Dr. Segman completed her internship in hematooncology at Ichilov Hospital after a number of meetings with Professor Irit Avivi attracted her to the field. Their path felt” that the right way to be a doctor is excellence, knowledge and empathy for the patient and family members, “she says.

How is the disease diagnosed?

“CLL is characterized by the accumulation of white blood cells of the lymphocyte type B cells. The accumulation of cells can occur in the blood, bone marrow, lymph nodes and spleen. “, Answers Dr. Segman.

“The course of the disease varies from patient to patient, depending on clinical characteristics and genetic and molecular changes. In some patients the disease is stable and progresses slowly over years and about a third of patients will never need treatment. Early treatment in several clinical trials.It is important to note that at the time of diagnosis complementary genetic and molecular clarification that help in some way predict the course of the disease and the frequency of follow.up. “Considerable lymph nodes or spleen – need treatment.”

What treatments are available today?

“CLL treatment has evolved and improved dramatically over the years. Today the goal of treatment includes not only controlling the symptoms of the disease and extending life expectancy, but balancing and maintaining the patient’s quality of life with the transition to personalized medicine,” explains Dr. Segman. Which include chemotherapy and biological antibodies directed against proteins expressed by disease cells.In recent years, targeted drugs that inhibit enzymes or proteins in disease cells have become available.This is a real breakthrough in the way chemotherapy has hitherto been based.

What are the side effects of the treatments?

“Most often, and depending on the characteristics of the disease, there are two treatment options,” explains Dr. Segman. They are given orally (tablet for swallowing) once or twice a day continuously. Common side effects are an increase in blood pressure, the appearance of edema, a skin rash, an increased risk of bleeding and cardiac arrhythmias. A second option is based on a protein inhibitor called BCL.2 Which gives a survival advantage to the cells CLL, in combination with an anti.CD20 antibody expressed by the malignant cells. This stage is timed (one or two years, depending on the treatment line for which it is given) and includes an intravenous infusion of the antibody for six months. The toxicity profile of this stage includes an increased risk of “tumor breakdown syndrome” when starting treatment as a result of rapid cell destruction, immune suppression and bone marrow suppression (decreased blood counts).

“It may sound scary, but it is important to note that each side effect has different degrees of severity and not every patient will experience the full range of side effects,” Dr. Segman emphasizes. The decision on one of the options is based on genetic and molecular characteristics The patient’s background.

A dynamic field that is growing and changing in order to improve the effectiveness of the treatments available to us | Illustration: CI Photos, shutterstock

What is the therapeutic future in the field ofCLL? Is it possible to talk about full healing?

“The goal is complete healing with timely treatment. For example, different stages of the drugs described above are being tested. The premise is that a synergistic effect will be created that will amplify the effect of the drugs when given together. The CLL from the lymph nodes to the blood, while the BCL.2 inhibitor Effective in destroying the cellsCLL mainly in the blood and bone marrow. Of course, there are unanswered questions about this treatment, such as the ideal duration of treatment and whether there are patients who need longer or intermittent treatment. ”

The ability to talk to a patient about healing attracted you to the field?

“Meteo.oncology is an endless field, but from the very beginning I was attracted to lymphoproliferative diseases. It is a dynamic field that grows and changes in order to improve the effectiveness of the treatments available to us, whether in response and duration or in improving safety profile and side effects. “Acquired again,” says Dr. Segman. For example, I have a patient who was diagnosed with CLL in 2013. He stubbornly refused to start treatment despite repeated hospitalizations and significant damage to his health.

What additional tools are available to patients CLL?

“I was recently exposed to the phrase ‘there is no joy as letting go of doubts’ that comes from my own book. Every person diagnosed with a malignant disease is ‘suddenly’ placed at a new crossroads characterized by ambiguity and fears. .

Want to know more about CLL? Meet the Khalil Haor Association, which is a support for leukemia and lymphoma patients and their families. It provides access to information as well as help with physical and mental support. Will be part of the drug basket.

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By Editor

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