HJNO Sep/Oct 2021

HEALTHCARE JOURNAL OF NEW ORLEANS I  SEP / OCT 2021 53 Janeiro Goffin, MD Medical Oncologist Mary Bird Perkins TGMC Cancer Center DIAGNOSIS • Flow cytometry in peripheral blood. If a diagnosis is not made by flow cytometry, usually your doctor might do a bone mar- row or lymph node biopsy. • CBC, CMP, uric acid, LDH, immunoglobu- lin levels. • IgHV mutation analysis. STAGING The Rai system for staging CLL is based on an analysis of how the body is affected by the abnormal lymphocytes. The original system had five stages, which were subse- quently organized into three “risk groups.” The higher numbers indicate a more ad- vanced stage of the disease: • Low risk (Stage 0): Increased numbers of abnormal lymphocytes are found in the blood or bone marrow, lymph nodes/ organs are not swollen and production of red blood cells and platelets is not signifi- cantly affected. • Intermediate risk (Stages I and II com- bined): Increased abnormal lymphocytes with enlarged lymph nodes, liver, and/or spleen. The production of red blood cells and platelets is not significantly affected. • High risk (Stages III and IV combined): Increased abnormal lymphocytes with a low red blood cell count (anemia) and/ or a low platelet count, with or without an enlarged spleen, liver or lymph nodes. TREATMENT CLL usually doesn’t require treatment and can be monitored with surveillance of blood work every 3-6 months. Treatment is required when: • Symptoms of anemia and/or low platelets (in particular, high-risk Rai stages III or IV or Binet stage C). • Disease-related symptoms such as se- vere fatigue, night sweats, unintentional weight loss, painful swelling of lymph nodes or spleen, or unexplained fever. • Extremely enlarged lymph nodes or spleen. • Complications from involvement of other organs (such as the skin, kidney, lung or spine). • Autoimmune hemolytic anemia (a con- dition in which the immune system de- stroys healthy red blood cells) or immune thrombocytopenia (a condition in which the immune system destroys healthy platelets) that does not respond to spe- cific treatment for these complications. • Cancer that is progressing quickly, as demonstrated by rapidly increasing white cells in the blood and/or rapidly enlarging lymph nodes, spleen or liver. • Recurring infections. Treatment might involve one or more of the following: • Targeted therapy: These are medicines that work only for cancers with certain characteristics. One example is a medi- cine called ibrutinib (Imbruvica) or aca- labrutinib (Calquence). Many people who need treatment for CLL get this medicine first. These medications are Bruton’s tyro- sine kinase inhibitors. Second-line treat- ments are usually regimens containing BCL-2 inhibitor venetoclax. Third-line treatments are generally the PI3Kinase inhibitors like duvelisib or idelalisib. • Antibodies: Antibodies are proteins in blood that the immune system makes to help our bodies fight infections. But there are other types of antibodies that are created in a lab and used as medicine. They kill cancer cells by targeting specific parts of the cells. Examples of these are rituximab or obinutuzumab. • Chemotherapy: Chemotherapy is the medical term for medicines that kill cancer cells or stop them from growing. In CLL, we usually use the FCR chemo- therapy regimen, which is fludarabine, cy- clophosphamide and rituximab. This regi- men is generally used in patients who are less than 65 years old with IgHVmutation. • Supportive treatment: People with CLL can get sick from infections more easily than usual. That’s why we check immu- noglobulin (Ig) levels and give them IVIg if the IgG levels are below 500 to pro- tect our patients against opportunistic infections. It’s important for the patient to wash their hands often and stay away frompeople who are sick. They should let their doctor or nurse know right away if they get a fever. Other supportive treat- ments could be red blood cell and platelet transfusion. • Clinical trials. • Stem cell transplantation. n JaneiroGoffin,MD, is amedical oncologist at theMary Bird Perkins Cancer Center at Terrebonne General in Houma. He is board-certified in internal medicine, hematology andmedical oncology by the American Board of Internal Medicine and is a current member of numerous local and national medical societies.He earned a medical degree at the American Univer- sity of Medical School in Nicaragua, completed an internal medicine residency at the Miller School of Medicine at the University of Miami andwas a hema- tology/oncology fellow atTulane University School of Medicine.Additionally,Goffin underwent clinical and research rotations at MDAnderson Cancer Center in Houston,Texas. “Unlike many other types of cancer, people with early-stage CLL do not benefit from early, aggressive treatment but instead, do better with careful, long-term monitoring of the disease.”