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ERIC CLL 2026 | Therapy-driven clonal dynamics in CLL: should clinicians repeat genomic profiling?
Richard Rosenquist, MD, PhD, Karolinska Institute, Solna, Sweden, discusses therapy-driven clonal dynamics in chronic lymphocytic leukemia (CLL), emphasizing the importance of retesting at progression. Prof. Rosenquist explains that in the targeted therapy era, clinicians should still retest before starting therapy to identify any changes in genetic aberrations, and retest at each line of therapy to detect potential changes in clonal composition that may inform treatment selection. This interview took place at the 2026 ERIC International Meeting in Barcelona, Spain.
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Transcript
So in the chemo-immunotherapy era we knew that we had to retest at progression because there was a high risk that you could have a TP53 aberration that emerged. Now in the targeted therapy era we also recommend to retest before start of therapy to see if there is anything that has changed regarding genetic aberrations. If there is not as strong pressure on TP53 aberrations as chemoimmunotherapy gave, but still there could be changes in the clonal composition at progression so that’s why we are recommending to redo the genomic tests besides that the IDH gene mutation status only has to be performed once because it’s stable but the other genomic markers you have to retest at each before start of each line of therapy in order to know if something has emerged that could give hints that you should select another treatment...
So in the chemo-immunotherapy era we knew that we had to retest at progression because there was a high risk that you could have a TP53 aberration that emerged. Now in the targeted therapy era we also recommend to retest before start of therapy to see if there is anything that has changed regarding genetic aberrations. If there is not as strong pressure on TP53 aberrations as chemoimmunotherapy gave, but still there could be changes in the clonal composition at progression so that’s why we are recommending to redo the genomic tests besides that the IDH gene mutation status only has to be performed once because it’s stable but the other genomic markers you have to retest at each before start of each line of therapy in order to know if something has emerged that could give hints that you should select another treatment.
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