Is CLL caused by some infectious agent? Even if not all CLL patients can trace their cancer to some infectious agent, is there a possibility that some percentage of patients would not have been diagnosed with CLL but for some infection just prior to their CLL diagnosis?  Or an infection long time ago, but where traces of the virus are still retained in the patient’s body?

You might be interested to know, a surprisingly significant percentage of CLL patients report they have had one or more bouts of pneumonia in the years just prior to their CLL diagnosis and I believe this correlation has been documented by NCI researchers.

And then there is everyone’s favorite villain, Epstein Barr virus.  In one of our admittedly unscientific polls, we found that a surprisingly large percentage of our members have had clinically diagnosed mononucleosis in their youth (that is “glandular fever” for our British members) - significantly more than in the general population. There is more rigorous research pointing to a connection between EBV and some lymphomas, as well as the dreaded Richter’s transformation.

That brings us to this very unusual clinical trial.  In a nutshell, they want to recruit very early stage and good prognosis patients who have not been treated in any way and certainly not ripe for treatment and treat them with nothing more than a cocktail of broad spectrum antibiotics.  The logic is that if there is indeed some underlying infection that is just barely simmering along - not enough to be detected or identified but enough to rile up the immune system into a state of chronic inflammation - can we hope that the antiobiotic cocktail will stop that infection dead in its tracks, and thereby stop the cancer as well?

This is not quite as crazy as it sounds.  There  has been a lot of interest in the role of chronic inflammation as the origin of immune system related cancers.  Constant goading by a pathogen into a high state of alert (i.e., inflammation) coupled with an inability to actually resolve the infection and get on with life may indeed cause our immune systems to “go postal” - become cancerous.

My beef with this clinical trial is that they are planning to use only antibiotics.  When we have identified pathogens as the cause of specific cancers, more often than not they are viruses.  And antibiotics do not work on viral infections.  For example, if indeed EBV has a role in the precipitation of CLL, the antibiotic therapy would do very little to stop that viral infection.  I wonder why they did not include a potent anti-viral drug in the mix.

Any case, here is the link to this clinical trial.  NCT01279252 You can read all about the inclusion criteria, contact information etc by clicking on the link.