I have been living with CLL since 2003 (high white cell count 25,0000) and I am
going on 75 yrs. In the last two years biopsy showed Primary Cutaneous Follicle Center Cell Lymphoma on several locations on my scalp. I have received Radiation Therapy 6 times 15 days each, but small tumors and red patches are back. My Hematologist/Oncologist wants to given me RITUXAN but only for the lymphoma, not for CLL.
My question is, is it advisable to have a FISH test to determine if I have chromosome 17 deletion and what % and test for TP53 to determine if RITUXAN will be effective. i do have many benign skin tumors on my back that indicates 17p and perhaps defective 53p.
Where can I go for the FISH test; I live in Southern CA.
Hi, you probably already know more than anybody here. But just to be a sounding board: the RTX binds to CD20, but CLL is known for fewer CD20s per B Cell than normal. Once it binds, it is less effective in killing the B cells because of the faulty P53. The P53 tumor suppressing action is needed for the apoptosis that should occur.
It sounds to me like a tossup. FISH is expensive, I assume you might be getting that on your own else your doc would tell you how to get it done. I'd guess they would ideally scrape a biopsy sample to test.
If the CLL cells have lower numbers of CD20, would the lymphoma cells also have lower CD20? That'd be a big question, too.
As you likely know, RTX is one of the mildest forms of treatment that there is, as far as side effects.
Thanks, Bob. You know, the cost of a FISH test must be top secret because I just can't find it online.
Here are three labs that do it:
I believe there are only a few in the country. E.g., a lab close by that can do Flow Cytometry probably can't do FISH. Samples have to be shipped out.
As I remember, the cost of Rituxan is roughly $6,000 per infusion.
I was curious if Rituxan could be used only in the actual lesions. Take a look at this, Bob:
Intralesional therapy with anti-CD20 monoclonal antibody rituximab: local and systemic efficacy in primary cutaneous B-cell lymphoma.
"We report the use of intralesional injections of rituximab into some but not all cutaneous lesions in a patient with multiple primary cutaneous follicular centre B-cell lymphoma. This treatment resulted in tumour regression, even of the lesions that had not been injected. We therefore hypothesize that there is systemic diffusion of rituximab from injected sites despite the low doses injected locally, or the induction of a specific antitumour immune response acting systemically."
Maybe that's what your doc is planning, but if not it sure looks like something to look into - just a few injections instead of a whole infusion.
Having injections instead of infusions doesn't address your main point, but it seems interesting.
Thanks Ken. Once again you have provided great information. From what I have read, RITUXAN infusion may be in the plan, but without determining chromosome 17p and p53 defective tumor suppressor, RITUXAN will not attach to the CD20 B-CELLS. There are clinical trials ongoing where RITUXAN has not worked and now doctors are trying FCR (monoclonal Rituxan with chemo). I was told at my age (75 ) chemo is out.
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