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ESH CLL 2026 | Genomic instability, clonal evolution, and BTK inhibitor efficacy in CLL
Romain Guièze, MD, PhD, CHU Clermont Ferrand, Clermont Ferrand, France, discusses the relationship between genomic instability and clonal evolution in chronic lymphocytic leukemia (CLL), emphasizing that BTK inhibitors remain highly effective even in high-risk patients with TP53 alterations. This interview took place at the ESH CLL 2026 congress in Stockholm, Sweden.
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Transcript
Yeah, so what was interesting with the… So the clonal evolution differs because the more genomic instability exists, the more clonal evolution results from this. So there is a great correlation between the number of event mutations or copy number variations, the genomic instability, and the clonal evolution. But with the BTK inhibitor, what was interesting from the very beginning, it was that it’s very effective against patients with high genomic instability such as those with TP53 alteration and so we recently have very long-term follow-up of one of the first ibrutinib trials indicating that there was no negative impact of TP53 alteration even when you look at the very long term...
Yeah, so what was interesting with the… So the clonal evolution differs because the more genomic instability exists, the more clonal evolution results from this. So there is a great correlation between the number of event mutations or copy number variations, the genomic instability, and the clonal evolution. But with the BTK inhibitor, what was interesting from the very beginning, it was that it’s very effective against patients with high genomic instability such as those with TP53 alteration and so we recently have very long-term follow-up of one of the first ibrutinib trials indicating that there was no negative impact of TP53 alteration even when you look at the very long term. So this treatment with covalent continuous treatment with BTK inhibitors is a very good option for patients with TP53 alteration that are those at high risk of genomic instability and clonal evolution.
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