Dr. Jennifer Brown on Gauging Response in CLL

Jennifer Brown, MD, PhD, Director, Chronic Lymphocytic Leukemia Center, Dana-Farber Cancer Institute, Assistant Professor of Medicine, Harvard Medical School, discusses gauging response in chronic lymphocytic leukemia (CLL).

Patients with CLL generally have an elevated lymphocyte count, Brown says, and the disease circulates in their blood. Patients are treated to reduce lymphocyte count in the blood as well as in lymph nodes. When treated with targeted therapies such as rituximab, bendamustine, everolimus, and fostamatinib, patients have good lymph node response and improve symptomatically but their lymphocyte count rises. Because of improvements to lymph nodes and symptoms, these patients do not have progressive disease.

Brown says that this population of patients see their white blood cell count rise, level off, then eventually go down. Over time, it has been determined that cells were coming out of lymph nodes and bone marrow and redistributing into the blood, which was associated with response to the drug. Though patients feel better, the activity cannot be technically classified as a response according to traditional criteria. Brown notes that criteria have since been altered and complete remission can be achieved more quickly with traditional agents such as antibodies or chemotherapy to clear the blood.