iwCLL 2021 | Prognostic markers for the treatment of CLL

In the iwCLL session we are discussing how to manage the patient with CLL in frontline. And the main topics were actually related to the definition of factors relevant for selecting treatment choice and how to define with the availability of novel agents, high-risk patients. Because standard predictive factors applied in the era of chemoimmunotherapy probably are not exactly applicable to the treatment with targeted agents. And these all through, with different factors, including TP53 aberrations. So, for example, complex karyotype and immunoglobulin gene mutation status and in particular stereotype subset still seem to play a relevant role in defining the depth of response and long-term disease control.

And also there are of course patient-related factors that should be taken into account when selecting first-line treatment, including the comorbidities profile, because many of the patients we are treating in first-line with targeted agents, of course, concomitant diseases that may influence, especially, the tolerance to novel treatments. And I’m particularly referring to cardiac comorbidities and impaired renal functions.

And also in this frontline session, we discuss if there is any role anymore for chemoimmunotherapy and Matthew Davids from Dana Farber presented actually the current available results of clinical trials, where a chemoimmunotherapy is combined with targeted agents to obtain deep and long lasting responses and still administer fixed duration or time limited treatments.

So, of course, patients who are candidates to chemoimmunotherapy combined with novel agents at a very, let’s say, specific profile, meaning that they are young without relevant comorbidities. So, in this setting the combination of chemoimmunotherapy and targeted agents is currently considered, but only in clinical trials. And we still have to see if there is any advantage in combining these different mechanism of actions in terms of long-term disease control.