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ESH CLL 2026 | The multiclonal nature of CLL and its role in resistance and relapse
Jennifer Brown, MD, PhD, Dana-Farber Cancer Institute, Boston, MA, discusses the multiclonal nature of chronic lymphocytic leukemia (CLL), highlighting how multiple disease clones can coexist throughout the disease course and may contribute to treatment resistance and relapse. This interview took place at the ESH CLL 2026 congress in Stockholm, Sweden.
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Transcript
It has really become clear in the last few years that CLL is a multi-clonal disease. I think we’ve always known to some extent that that was true in the very early stages, the pre-CLL stages that we call monoclonal B-cell lymphocytosis, where patients often have multiple clones. And then it’s also become very clear in the setting of resistance that patients develop multiple clones. But it seems that these clones exist throughout the course of the disease, even at the level of the B cell receptor, which is very interesting...
It has really become clear in the last few years that CLL is a multi-clonal disease. I think we’ve always known to some extent that that was true in the very early stages, the pre-CLL stages that we call monoclonal B-cell lymphocytosis, where patients often have multiple clones. And then it’s also become very clear in the setting of resistance that patients develop multiple clones. But it seems that these clones exist throughout the course of the disease, even at the level of the B cell receptor, which is very interesting. We’re still trying to understand how this multi-clonality really affects disease management. We still tend to treat the major clone, and especially in terms of the immunoglobulin heavy chain status, we usually get one result that represents the main clone, and then that guides our treatment decision-making. I think the place where the multi-clonality really comes out is in the setting of patients who’ve been treated before in relapse and who often have multiple clones that can develop into recurrent disease more quickly in the relapse setting.
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