Добрый день. Был на приеме онкогематолога. Аналогично сказали, ждать.
Но мне написал один очень известный профессор из Израиля.
1. I have no data on your clinical condition and lab results.
2. You sent me results of flow cytometry only. All antigens but CD5 are compatible with CLL, CD5 is very important for diagnosis of classic CLL and in your case is surprisingly low. (may be to repeat later?).
3. Treatment in CLL is administered only with specific indication, not at the time of diagnosis, but when is "no choice" not to treat active disease. Early treatment doesn’t prevent late problems.
4. Unfortunately, it is not true that currently cure in CLL exists, CLL remains to be chronic disease.
5. Up to recent years the standard treatment was immunotherapy that is able to give years of remission. Currently novel agents change the landscape of treatment and some researchers in CLL (more in the USA) already don't use chemotherapy. In my opinion, it is early to conclude that chemotherapy died in CLL. All type of treatment has its benefits and problems.
6. The decision to start treatment and the fact of need for intervention is much more important that the choice of therapy.
7. Important to perform stratification before start of treatment. I hope that in specialized hematology centers in Russia there is a facility to perform genetic test by FISH. Then, if you find chromosome 17p deletion (and probably!!!? 11q deletion), there is no place for chemotherapy, only novel agents should be given. Only several centers (in Israel) perform additional analysis of TP53 mutation status.
8. New data show that IGVH mutation status is also important for the choice of therapy. For cases with Unmutation status novel agents are preferable.
9. I repeat that all these disputes are relevant only at time of indication of therapy and absolutely not before.
Что скажете?
Может сделать анализ FISH и мутацию TP53 . Ведь это долгие анализы, которые проводят в течение 2-3 месяцев.
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