Dr. Skarbnik on Treatment Considerations in CLL

Alan P. Z. Skarbnik, MD, a hematologist/oncologist with Novant Health, discusses treatment considerations in chronic lymphocytic leukemia (CLL).

CLL is a heterogeneous disease, says Skarbnik. Some patients may present in different ways with different sub genetics that will differentiate their risk for progression, as well as the implication for their optimal therapy. Factors to consider include IGHV mutational status, fluorescence in situ hybridization (FISH) score, del(17p), and 11q13, which is not as important as previously thought but can help to guide treatment away from less optimal therapies, such as chemotherapy, Skarbnik explains. TP53 mutations are also considered, which may be present even in the absence of del(17p). Karyotyping a patient is also necessary, as it reveals complex cytogenetics that are not normally captured by FISH, such as 3 or more cytogenetic abnormalities, explains Skarbnik. These factors suggest a complex risk for progression and resistance. 

Based on the previous factors in addition to age, presentation, and risk, the optimal treatment for patients with CLL is then decided, concludes Skarbnik.