Advances in the molecular stratification of chronic lymphocytic leukemia

Anna Schuh, MD, PhD, from the University of Oxford, UK, gives an overview of her talk on the advances in the molecular stratification of chronic lymphocytic leukemia (CLL). The focus of the talk was to make sense of the biological and clinical heterogeneity of CLL patients. The fludarabine, cyclophosphamide and rituximab (FCR) therapy is still the standard of care frontline treatment and while data shows that many patients respond very well or have even shown to be cured, around 25% of patients will relapse within the first two years of having received chemoimmunotherapy according to Dr Schuh. Molecular markers may be able to help with giving the right treatment at the right time to the right patient, according to Dr Schuh. Deletions of 17p and TP53 for example, confer poor prognosis and this has been confirmed by several studies. Dr Schuh talks about how only one-third of clinicians request TP53 mutation analysis, which means that there is a need for further education among clinicians. With the advent of next-generation sequencing (NGS), there is now a tool available that can detect smaller subclonal mutations and data from the ARCTIC trial for example, suggests that patients with subclonal mutations of TP53 have an equally poor prognosis as patients with clonal TP53 mutations. Dr Schuh discusses how the improvements in diagnostics technology have implications for clinical practice. According to Dr Schuh, the NGS technology should now be used to identify high-risk patients who will not benefit from FCR treatment.
Recorded at the 2016 Annual Meeting of the British Society of Haematology (BSH) and International Society of Hematology (ISH), held in Glasgow, Scotland,

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