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Diagnosis and prognosis in CLL/SLL
Paolo Ghia, Davide Rossi and Anna Schuh discuss diagnosis and prognosis in CLL, including a case study on the differential diagnosis of accelerated CLL and Richter’s syndrome and a debate on the clinical relevance of IGHV and TP53 as biomarkers.
Speakers
Update on CLL diagnosis and prognostic markers in clinical practice
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5th Edition of the WHO classification of hemopoietic and lymphoid malignancies
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Guideline recommendations: Mutation analysis
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The PAST: deletions and/or mutations of TP53 on chromosome 17p
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Long term follow-up of the RESONATE trial
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TP53 underlying disruption
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CLL subclones: Sensitive detection tools are required
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SEQUOIA: Phase III randomized study of zanubrutinib vs. BR
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The IGHV locus: % homology; stereotypy; MRD targets
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Patients with mutated IGHV respond well to FCR
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Predictive value of MRD applies to immunochemotherapy
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PFS and OS analyses based on PB MRD status at EoT in patients after 2 years of VenR
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Duration of treatment is defined by MRD measurement (FLAIR)
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MRD: What does the FDA say? What do the experts say?
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Using whole genome sequencing to further predict the outcome in CLL
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Diagnosis and prognosis in CLL/SLL: Summary
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Differential diagnosis of accelerated CLL and Richter’s syndrome
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Case study: Progressive lymphoma
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Richter’s Syndrome: Definition and comparison of related and unrelated variants
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Differential diagnosis: Histologically aggressive CLL
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Pathological definitions of aggressive CLL and Richter syndrome
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Differential diagnosis of accelerated CLL and Richter’s syndrome: Summary
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IGHV and TP53 are clinically relevant biomarkers
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IGHV and TP53 are no longer clinically relevant biomarkers
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Audience Q&A
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If a patient has Richter syndrome, and following initial treatment bone marrow shows 3% CLL cells, what is the best approach for treatment?
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What is your opinion on novel PET radio tracers and PET MRI to distinguish CLL from accelerated CLL and Richter’s syndrome?
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Would earlier intervention reduce the number of cases of Richter’s syndrome?
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Do we know if TP53 is a prognostic marker for zanubrutinib over acalabrutinib?
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Are there any biomarkers to help choose between targeted therapies for CLL?
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Would you use anti-CD20 therapy in a patient with NOTCH1 mutations?
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Is there any distinction between TP53 deletion and TP53 mutation, and is there any relevance of the type of allelic inactivation?
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Is there any role of repeating covalent BTK inhibitors in patients treated with venetoclax and already exposed to BTKis?
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Are there any distinguishing features between the efficacy or patient profiles of zanubrutinib or acalabrutinib?
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Are there any new biomarkers to differentiate the CLL subtypes?
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Meeting summary
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