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ESH CLL 2026 | Key biomarkers for risk stratification in CLL
Anne-Sophie Michallet, MD, PhD, Léon Bérard Center, Lyon, France, discusses key biomarkers used for risk stratification in chronic lymphocytic leukemia (CLL), including IGHV mutation status, TP53 alterations, and complex cytogenetics, as well as immunogenetic subsets associated with aggressive disease and increased risk of Richter transformation. This interview took place at the ESH CLL 2026 congress in Stockholm, Sweden.
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Transcript
According to the French recommendation in France, we have three biomarkers very important to take into account to determine the best strategies. The first one is the IGHV mutational status, the second one is TP53 mutation, and the third one is complex cytogenotype. Of course, we have to take into account these two points, IGHV status and TP53 mutation, and for the patient with TP53 mutation, we consider this patient as high-risk patient, and we treat differently as patient without TP53 mutation...
According to the French recommendation in France, we have three biomarkers very important to take into account to determine the best strategies. The first one is the IGHV mutational status, the second one is TP53 mutation, and the third one is complex cytogenotype. Of course, we have to take into account these two points, IGHV status and TP53 mutation, and for the patient with TP53 mutation, we consider this patient as high-risk patient, and we treat differently as patient without TP53 mutation. And for the mutational status, we separate the patient between mutated and unmutated for the type of therapy you can give to them. For the patient with TP53 mutation, considered a high-risk patient, the recommendation of the French Innovative Leukemia Organization is to go to continuous BTK. For the patient without TP53 mutation with mutated IGHV status, the risk stratification in first is the fixed duration like obinutuzumab. And for the unmutated patient without TP53, we can use all treatment between fixed duration strategy or BTK continuous treatment. Beyond TP53, of course, and IGHV status, we have to take into account the complex cytogenotype, which is considered as high-risk patient. And we have to take into account also the subset, because subset 2 is associated with aggressive disease, and the subset 8 is associated with a true risk of Richter’s transformation. So we have to take into account the TP53, IGHV status, but also complex cytogenotype and subset.
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