The shrinking role of chemotherapy in the treatment of chronic lymphocytic leukemia.

INTRODUCTION: The therapeutic landscape of chronic lymphocytic leukemia (CLL) has changed significantly since the first targeted therapy, rituximab, was approved for the treatment of symptomatic patients. Areas covered: Multiple monoclonal antibodies (mAbs) and small molecule inhibitors (SMIs) that target the B-cell receptor (BCR) and BCL-2 pathways are now approved treatments for CLL patients. Recent and emerging clinical data investigating the use of targeted therapies in the treatment of CLL patients will be reviewed. The changing role of cytotoxic chemotherapy in the treatment of the CLL patient as a result of the increasing availability of novel targeted therapies will be discussed. Expert commentary: Use of novel therapies is progressively shifting much of the treatment of CLL patients towards a targeted therapeutic approach. Increasing availability of targeted agents such as SMIs will likely reduce the role of cytotoxic chemotherapy in the treatment of both front-line and relapsed/refractory CLL patients.

Reducing the Time From Diagnosis to Treatment of Patients With Stage II/III Rectal Cancer at a Large Public Hospital.

Curative-intent therapy for stage II/III rectal cancer is necessarily complex. Current guidelines by the National Comprehensive Cancer Network recommend preoperative concurrent chemoradiation followed by resection and additional adjuvant chemotherapy. We used standard quality improvement methodology to implement a cost-effective intervention that reduced the time from diagnosis to treatment of patients with stage II/III rectal cancer by approximately 30% in a large public hospital in Houston, Texas. Implementation of the program resulted in a reduction in time from pathologic diagnosis to treatment of 29% overall, from 62 to 44 days. These gains were cost neutral and resulted from improvements in scheduling and coordination of care alone. Our results suggest that: (1) quality improvement methodology can be successfully applied to multidisciplinary cancer care, (2) effective interventions can be cost neutral, and (3) effective strategies can overcome complexities such as having multiple sites of care, high staff turnover, and resource limitations.

Outcome of Patients With Nonsecretory Multiple Myeloma After Autologous Hematopoietic Stem Cell Transplantation.

INTRODUCTION: Fewer than 5% of patients have nonsecretory multiple myeloma (NSM), which is characterized by the absence of monoclonal protein in immunofixation in serum and urine. There are limited data on the outcome of NSM after autologous hematopoietic stem cell transplantation (auto-HCT). PATIENTS AND METHODS: Between 1988 and December 2010, we identified 31 patients with NSM, and compared their outcome with 124 patients with secretory myeloma (SM) who were matched for age, disease stage, year of auto-HCT, and disease status and received auto-HCT at our institution. The primary end points were time to progression (TTP), progression-free survival (PFS), and overall survival (OS). RESULTS: Nonrelapse mortality at 4 years was 4% and 4% in the NSM and SM patients, respectively (P = .612). Median follow-up was 102 and 74 months for NSM and SM patients, respectively. Median PFS was 37 (95% confidence interval [CI], 12-62) and 22 (95% CI, 18-26) months for NSM and SM patients, respectively (P = .527). Median OS was 51 (95% CI, 7-95) and 73 (95% CI, 59-86) months for NSM and SM patients, respectively (P = .740). In multivariate analyses, age >55 years, and relapsed disease were associated with a shorter TTP. Similarly, age >55 years, and relapsed or refractory disease at the time of auto-HCT were associated with a shorter OS. CONCLUSION: Auto-HCT is associated with durable remission in NSM. There was no significant difference in transplant-related mortality, TTP, and PFS in patients with NSM compared with patients with SM after high-dose therapy and auto-HCT.