On July 23, 2014, the U.S. Food and Drug Administration (FDA) approved idelalisib (Zydelig tablets, GileadSciences, Inc.) for the treatment of patients with relapsed chronic lymphocytic leukemia (CLL), in combination with rituximab, for whom rituximab alone would be considered appropriate therapy due to other co-morbidities.
Zydelig is a kinase inhibitor indicated for the treatment of patients with:
• Relapsed chronic lymphocytic leukemia (CLL), in combination with rituximab, in patients for whom rituximab alone would be considered appropriate therapy due to other co-morbidities.
• Relapsed follicular B-cell non-Hodgkin lymphoma (FL) in patients
who have received at least two prior systemic therapies. (1.2)
• Relapsed small lymphocytic lymphoma (SLL) in patients who have
received at least two prior systemic therapies. (1.3)
Two patients with classic chronic lymphocytic leukemia had meningeal leukemia as a complication of their disease. Intrathecal chemotherapy was successful in eradicating signs and symptoms of meningeal involvement. One of these patients is alive without evidence of central nervous system leukemia 30 months after diagnosis of meningeal leukemia, and 5½ years after the diagnosis of chronic lymphocytic leukemia. Although uncommon, meningeal involvement in chronic lymphocytic leukemia may occur at various times in the course of the disease, it responds to conventional therapy.
Cerebrospinal fluid from a patient
56-year-old male with chronic lymphocytic leukemia that was diagnosed shortly after he presented in 1974 with increased lymphocytes in his blood (lymphocytosis), enlargement of the spleen (blood tumor there too) [splenomegaly]) A bone marrow biopsy showed 80% lymphocytes.
The patient received chemotherapy with cyclophosphamide, vincristine, and the anti-inflammatory medicaiton prednisone, This treatment resulted in remission (went away) of the tumor burden (killed most of these tumor cells), but it did not kill them all. you can only give so much chemotherapy because it kills the healthy cells and the tumor cells.
Leukocyte count 253/mm(3) with 100% mature lymphocytes. The patient underwent cranial radiation, and received two doses of intrathecal (within the meninges)0 methotrexate with clearing of his symptoms. Progressive inanition (wasting) developed, and he died with congestive heart failure. four months after the meningeal leukemia (arachnoid membranes are one of the layers of the meninges), in 1976 . He did not have meningeal leukemia again prior to death (it was elsewhere though, a bone marrow is used in many patients with lymphoma, a key part of the workup, in contrast to what the medical board might assert).
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