Perspectives for CLL patients and their families
If, after a diagnosis of chronic lymphocytic leukaemia (CLL), you are looking for a treatment that suits you, you are on the right way to find it. Nowadays modern therapies are tailor-made for the patient, in this article, it will emerge clearly how much the evolution of the therapy allows to adjust the treatment on the patient.
What is chronic lymphocytic leukaemia?
Chronic lymphocytic leukaemia (CLL) is a type of cancer of the bone and blood marrow.
CLL can be asymptomatic, symptomatic or progressive, refractory, or recurrent.
- Asymptomatic CLL: The leukaemia causes no or few symptoms.
- Symptomatic or progressive CLL: The leukaemia has caused significant changes to blood counts or other serious symptoms.
- Recurrent CLL: The leukaemia has recurred (come back) after a period in which cancer could not be detected.
- Refractory CLL: The leukaemia does not get better with treatment.
CLL is one of the most common types of leukaemia in adults. It often occurs during or after middle age. However, it is important to understand that this cancer gets worse slowly. The first treatment approach is to watch and wait, which is a way of monitoring with regular check-ups and blood tests. The idea of standing and watching without doing anything can be challenging for many patients, but it is important to know that learning to live in an active form with CLL is the most powerful approach to managing this cancer.
How is chronic lymphocytic leukaemia diagnosed?
Several tests are done to find out the staging of CLL, the process used to find out how far cancer has spread. It is important to know whether the leukaemia cells have spread to plan the best treatment.
The stages go from 0 to IV, as follows:
- In stage 0 there are too many lymphocytes in the blood, but there are no other signs or symptoms of leukaemia. We are in a slow-growing phase.
- In stage I there are too many lymphocytes in the blood and the lymph nodes are larger than normal.
- In stage II there are too many lymphocytes in the blood, the liver or spleen is larger than normal, and the lymph nodes may be larger than normal.
- In stage III there are too many lymphocytes in the blood and there are too few red blood cells. The lymph nodes, liver, or spleen may be larger than normal.
- In stage IV there are too many lymphocytes in the blood and too few platelets. The lymph nodes, liver, or spleen may be larger than normal or there may be too few red blood cells.
The currently used treatment are standard and some are being tested in clinical trials.
How is chronic lymphocytic leukaemia treated?
There are six types of treatment currently in use, from targeted therapy to immunotherapy.
Targeted therapies
Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells. Targeted therapies usually cause less harm to normal cells than chemotherapy or radiation therapy does.
Different types of targeted therapy are used to treat CLL:
- Tyrosine kinase inhibitor (TKI) therapy: This treatment blocks the enzyme, tyrosine kinase, which causes stem cells to develop into more white blood cells than the body needs. Ibrutinib, acalabrutinib, idelalisib, and duvelisib are TKIs used to treat symptomatic or progressive, recurrent, or refractory CLL.
- BCL2 inhibitor therapy: This treatment blocks a protein called BCL2 which is found in some leukaemia cells. This may kill leukaemia cells and make them more sensitive to other anticancer drugs. Venetoclax is a type of BCL2 therapy used to treat symptomatic or progressive, recurrent, or refractory CLL.
- Monoclonal antibody therapy: Monoclonal antibodies are immune system proteins made in the laboratory to treat many diseases, including cancer. As a cancer treatment, these antibodies can attach to a specific target on cancer cells or other cells that may help cancer cells grow. The antibodies are able to then kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells. Rituximab, ofatumumab, and obinutuzumab alone and in combination with chemotherapy are used to treat symptomatic or progressive, recurrent, or refractory CLL.
- Alemtuzumab has been studied for the treatment of CLL. Studies showed that alemtuzumab did not help patients live longer.
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). Combination chemotherapy is treatment using more than one anticancer drug.
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy X-rays or other types of radiation to kill cancer cells or keep them from growing. External radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer, such as a group of lymph nodes or the spleen. This treatment may be used to reduce pain related to a swollen spleen or lymph nodes.
Immunotherapy
Immunotherapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defences against cancer. This cancer treatment is a type of biological therapy. Immunomodulating agent: Lenalidomide stimulates T cells to kill leukaemia cells. It may be used alone or with rituximab in patients with symptomatic or progressive, recurrent, or refractory CLL.
CAR T-cell therapy
This treatment changes the patient’s T cells (a type of immune system cell) so they will attack certain proteins on the surface of cancer cells. T cells are taken from the patient and special receptors are added to their surface in the laboratory. The changed cells are called chimeric antigen receptor (CAR) T cells. The CAR T cells are grown in the laboratory and given to the patient by infusion. The CAR T cells multiply in the patient’s blood and attack cancer cells. CAR T-cell therapy is being studied in the treatment of recurrent or refractory CLL.
Chemotherapy with bone marrow or peripheral stem cell transplant
Chemotherapy is given to kill cancer cells. Healthy cells, including blood-forming cells, are destroyed by the cancer treatment. A bone marrow or peripheral stem cell transplant are treatments to replace the blood-forming cells. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the patient completes chemotherapy, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body’s blood cells.
Treatment options depend on the red blood cell, white blood cell, and platelet blood counts, whether the liver, spleen, or lymph nodes are larger than normal, the age and health of the patient at the time of diagnosis and whether there are signs or symptoms, such as fever, chills, or weight loss, the response to initial treatment and whether the CLL has recurred.
Each cancer treatment and cancer can cause side effects. Keep in mind that side effects vary from person to person, even among people receiving the same type of cancer treatment. Speak up about any problems you have. Your health care team can treat and/or talk with you about ways to reduce side effects, so you feel better.
You can get more help from the Chronic Lymphocytic Leukaemia Association where you live and of course, your physician can help you to choose the best option for you.
Disclaimer
The information contained herein is not and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Before making any changes to your diet, exercise or treatment, always consult your doctor or a qualified health professional.
The guidance provided may not be appropriate for your specific situation. Never make any decisions about your health based solely on the information provided in this article.
The author and creator of this article are not responsible for any damage or loss resulting from the improper use of the information presented here. Remember that each person is unique and therefore needs a personalized approach to health.
If you have any concerns about your health, please consult a qualified medical professional.
In this article, you can find a description and an explanation of how chronic lymphocytic leukaemia, a type of cancer that is in early phases asymptomatic, is identified and treated.
What is chronic lymphocytic leukaemia?
Chronic lymphocytic leukaemia (CLL) is a type of blood cancer (leukaemia) that starts in lymphocytes, the white blood cells, located in the bone marrow.
As a result of the leukaemia cells replacing the bone marrow’s normal blood-making cells, people with CLL don’t have enough red blood cells (anemia), properly functioning white blood cells (leukopenia), and blood platelets (thrombocytopenia).
The shortage of red blood cells causes tiredness, weakness, and shortness of breath. CLL also increases the risk of infections. People with CLL may have very high white blood cell counts because of excess numbers of lymphocytes (lymphocytosis), but the leukaemia cells don’t fight infection the way normal white blood cells do. This is mainly because their immune systems aren’t working as well as they should.
CLL is a cancer of B lymphocytes, which normally make antibodies that help fight infection. Because of the CLL, these antibody-making cells don’t work as they should, so they can’t fight infections. Infections may range from simple things like frequent colds or cold sores to pneumonia and other serious infections.
CLL can also affect the immune system in other ways. In some people with CLL, the immune system cells make abnormal antibodies that attack normal blood cells. This is known as autoimmunity.
How common is chronic lymphocytic leukaemia?
CLL accounts for about one-third of all leukaemias. The risk is slightly higher in men than in women, in particular, older adults up to 70 years. CLL is rarely seen in people under age 40 and is extremely rare in children.
What are the symptoms of chronic lymphocytic leukaemia?
Most of the time, CLL is asymptomatic or the symptoms are often vague and can be symptoms of other things.
Common symptoms can include the following:
- Weakness
- Feeling tired
- Weight loss
- Chills
- Fever
- Night sweats
- Swollen lymph nodes (often felt as lumps under the skin)
- Pain or a sense of „fullness“ in the belly (this can make someone feel full after only a small meal), which is caused by an enlarged spleen and/or liver
How is chronic lymphocytic leukaemia diagnosed?
Leukaemia is often found when your doctor orders blood tests for some unrelated health problem or during a routine check-up and you are found to have a high number of lymphocytes.
What are the risk factors for chronic lymphocytic leukaemia?
CLL is a complicated illness with a variety of consequences. One positive is that it starts and develops slowly over several years, before becoming chronic.
There are very few known risk factors for CLL. These include:
- Age: the risk of CLL goes up as you get older. About 9 out of 10 people with CLL are over age 50.
- Exposure to certain chemicals: Some studies have linked exposure to Agent Orange, an herbicide used during the Vietnam War, to an increased risk of CLL. Some other studies have suggested that farming and long-term exposure to certain pesticides may be linked to an increased risk of CLL. However, research is limited.
- Family history: First-degree relatives (parents, siblings, or children) of people with CLL have more than twice the risk.
- Gender: CLL is slightly more common in males than females. The reasons for this are not known.
- Race/ethnicity: CLL is more common in North America and Europe than in Asia. Asian people who live in the United States do not have a higher risk than those living in Asia. This is why experts think the differences in risk are related to genetics rather than environmental factors.
But risk factors don’t tell us everything. Having a risk factor, or even many risk factors doesn’t mean that you will get the disease. And some people who get the disease may not have had any known risk factors. Even if a person has a risk factor and develops cancer, it’s often very hard to know how much that risk factor may have contributed to the cancer.
What are the treatments for chronic lymphocytic leukaemia?
If you have a CLL diagnosis, it’s important to take time and think about your treatment options. Because CLL often grows slowly, not everyone needs to be treated right away. The likely benefits and side effects of each treatment have to be taken into consideration.
When treatment is needed, the main treatments are:
- Chemotherapy
- Monoclonal antibodies
- Targeted therapy drugs
- Supportive care
- Stem cell transplant
Each therapy has to be dosed on the patient‘s characteristics, which is why it is important to choose the right therapy and adapt it to your unique needs.
What is the plan if you have chronic lymphocytic leukaemia?
Remember that you are not alone in this journey. There are many specialists and centers already up to date with the possible therapies. In many cases, the first and best option is to monitor the illness in its slow development. As this phase can last several years, the watch-and-wait approach, also called “active surveillance” or “watchful waiting “, which includes regular medical examinations, is almost always adopted.
You may feel concerned to then learn that you will not begin treatment right away. But the watch-and-wait approach in comparison with several treatments is one of the most powerful treatments available today.
Many studies have compared the watch-and-wait approach to an early treatment approach for people with low-risk CLL:
- To date, no benefits of early treatment for people with low-risk CLL have been shown.
- Several studies have confirmed that the use of alkylating agents or aggressive chemotherapy in patients with an early-stage disease does not prolong survival.
- There are risks of early treatment, including potential side effects and treatment complications.
- Patients may build up a resistance to the drugs used and would not be able to use them again when treatment for the progressive disease is necessary.
You may be feeling overwhelmed or flooded with information coming from the internet or well-meaning friends and family who are concerned for you. It is best, after your doctor, to go to the chronic lymphocytic leukaemia treatment center closest to where you live. There you can find not only all the information you want but also the names of the most suitable specialists to follow your case.
As time is gentle with you and this kind of illness, it is a good idea to seek a second opinion. A second opinion can give you more information and help you feel more confident about the treatment plan you choose.
Disclaimer
The information contained herein is not and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Before making any changes to your diet, exercise or treatment, always consult your doctor or a qualified health professional.
The guidance provided may not be appropriate for your specific situation. Never make any decisions about your health based solely on the information provided in this article.
The author and creator of this article are not responsible for any damage or loss resulting from the improper use of the information presented here. Remember that each person is unique and therefore needs a personalized approach to health.
If you have any concerns about your health, please consult a qualified medical professional.
Introduction
Medical writing is part of clinical studies from the beginning until the end, as it is fundamental for all regulatory documents needed throughout the trial.You need to have a skill set that combines excellent writing skills and analytical thinking to be successful in medical writing. Professionals in the medical writing field must be able to communicate with clients and are required to work with statisticians, clinical data managers, professionals in regulatory affairs, and last but not least clients.
Medical writers oversee making the field of medicine more accessible to the general public
They can engage in several projects at once and meet tight deadlines. In terms of skills, medical writers have a good command of English, competent when interpreting clinical & scientific data, and are capable of producing work for various audiences. Medical writers know about medical terminology and conditions, as well as statistics & regulatory environments. They welcome critique to improve their quality and take suggestions from clients or staff alike.
Medical writing is a specialized form of writing that helps doctors, nurses, and other healthcare professionals communicate with patients and provide care. Though the field is growing more complex by the day, there are some definite benefits to having a skilled medical writer on your team.
What does a medical writer do?
Medical writing is the process of putting together accurate and complete medical reports. To create these reports, a medical writer must have a good understanding of medical terminology and the scientific method. Additionally, a medical writer must be able to effectively communicate with physicians and other healthcare professionals.
While the role of a medical writer is inherently complex, the rewards are abundantly evident. Medical writing can help ensure that important information is conveyed accurately and in a way that is easily understood. Additionally, well-crafted medical reports can help identify potential health issues early on, potentially saving patients from serious consequences.
However, while the role of a medical writer is rewarding, it is also demanding. A good understanding of medical terminology and the scientific method is critical to producing accurate reports. Additionally, a strong ability to communicate with physicians and other healthcare professionals is essential to ensure that important information reaches its intended audience.
Daily routine of a medical writer
There is no one right answer to this aspect, as the daily routine of a medical writer can vary depending on the specific writing assignment. However, most medical writers typically spend part of their day researching and writing drafts of articles or papers. They may also be responsible for maintaining a Medical Writing blog or website, attending conferences and other events related to medical writing, and corresponding with clients or other sources of information.
Medical writers typically enjoy working with a variety of sources of information and developing creative ideas. However, they may find that they need to be disciplined to meet deadlines and produce high-quality work. Additionally, many medical writers are required to have experience in a specific area of medical writing (such as health policy or clinical research) to be successful.
Role of a medical writer in a clinical trial
Medical writing can be defined as the process of creating communication that assists in the diagnosis, treatment, and prevention of disease. A medical writer is typically involved in a clinical trial as part of the research and writing team. However, many medical writers work independently. The role of a medical writer in a clinical trial can vary greatly depending on the specific trial. However, most medical writers play a critical role in communicating the results of the study to both the research participants and the general public.
Principal skills of a medical writer
One of the principal skills of a medical writer is writing clearly and concisely. Medical writers need to be able to relay complex information in a way that is easy for patients and doctors to understand. They also need to be able to navigate through complex bureaucratic systems and find appropriate sources of information. Finally, medical writers must be able to produce high-quality, error-free content.
Is medical writing boring?
No, medical writing is not boring. It can be quite fascinating and informative. However, like any other form of writing, there are pros and cons to writing medical content. Here are some things to keep in mind when writing about medical topics:
Pros
-Medical writing can be very informative and helpful for readers.
-It can help communicate complex ideas to a wider audience.
Cons
-Medical writing requires high organizational skills and strong multitasking abilities.
-It can be difficult to find accurate information when writing about medical topics.
Is medical writing a good career?
There are many pros to pursuing a career in medical writing. Here are a few of the more important pros:
- Excellent pay and benefits. Medical writing can be a lucrative career, with excellent pay and benefits. Depending on experience and qualifications, medical writers may earn upwards of $60,000 per year. In addition, many hospitals offer excellent benefits, including health insurance and retirement plans.
- Variety and challenge. As a medical writer, you will be constantly challenged to improve your writing skills and find new ways to communicate information effectively. This is a highly demanding field, which always offers opportunities for growth and advancement.
- Good working environment. Medical writers typically work in comfortable office settings with supportive colleagues. The work can be physically demanding at times, but most medical writers find the job rewarding in terms of its impact on people’s lives.
- Flexible working hours. Most medical writers work flexible hours, allowing them to accommodate other commitments (such as family responsibilities) without having to sacrifice their employment status.
What does a medical writer in regulatory writing do?
A medical writer in regulatory writing does basic research to understand the regulations and how they apply to the topic at hand. They also help draft the official documents that explain these regulations to those who will be affected by them. Finally, they ensure that all written materials are accurate and easy to understand.
Conclusion
Medical writing can be an incredibly rewarding career, with a variety of benefits and opportunities. However, it comes with several challenges as well, which is why it’s important to carefully consider whether medical writing is the right path for you before starting your career.
