Current Approaches to Assessing Patients With CLL

Alexey Danilov, MD, PhD: Hello. Thank you for joining us for this OncLive® webinar titled “Updates in CLL: Optimizing Testing Rates.” Our objectives are to discuss standards of care and testing guidelines for patients with chronic lymphocytic leukemia [CLL]; take an in-depth look at prognostic testing considerations, staging, and treatment selection; and obtain insight into institutional testing protocols and practices. Please submit questions for our Q&A portion of the program.

I’m Alexey Danilov, a professor of hematology and hematopoietic stem cell transplant at City of Hope [in Duarte, California], where I lead the lymphoma program. I’m joined by Dr Anthony Mato, who’s the director of the CLL program at Memorial Sloan Kettering Cancer Center in New York [New York]. We’ll kick off this meeting with a discussion on diagnostic and prognostic testing in chronic lymphocytic leukemia. The first question we’d like to discuss is, who should receive such testing, and at what point? Dr Mato, how do you use diagnostic and prognostic testing for CLL?

Anthony Mato, MD, MSCE: Great question. Alexey, let’s go with the first names tonight. We’ll keep this as informal as possible. I’m a proponent of testing for the molecular genetic profile of patients at the time of diagnosis, even though you could argue that the information might not be useful for making a treatment decision for the vast majority of patients who are followed clinically. But it gives insight into the biology of the disease and, later on, clonal evolution. In addition, at our center, sequencing for IGHV status allows us to use in-house testing later on for MRD [minimal residual disease] testing that we’re able to do by next-generation sequencing. We do next-generation sequencing, IGHV testing, and FISH [fluorescence in situ hybridization] and array at the time of diagnosis.

Alexey Danilov, MD, PhD: We perform testing in a similar way. Sometimes we discuss with the patient their preference for when to do this testing, but at a minimum, every patient on whom you’re planning CLL therapy should get a full panel of tests. Just like you guys, we use karyotyping and FISH for common abnormalities. It would typically also include t(11;14) to rule out mantle cell lymphoma, as well as a next-generation sequencing panel. The latter is still very important in the current day and age because a fraction of patients who come up with normal FISH or a common FISH abnormality, like deletion 13q, may have some negative prognostic factors on next-generation sequencing panels, such as the TP53 mutation. It’s rare in previously untreated patients, but with a frequency of about 5%, it’s very important and has critical implications for treatment.

Transcript edited for clarity.