Dr. Bociek on the Evolving Role of Prognostic Factors in CLL

R. Gregory Bociek, MD, associate professor of internal medicine, Division of Oncology and Hematology, program director, Hematology/Oncology Fellowship Program, University of Nebraska Medical Center, discusses the evolving role of prognostic factors in chronic lymphocytic leukemia (CLL).

Real-world data have reported that prognostic testing for fluorescence in situ hybridization (FISH) cytogenetics and immunoglobulin heavy chain (IgH) status is underutilized in patients with CLL, which can lead to poorer outcomes in patients with poor-risk genetics who are treated with chemoimmunotherapy. Although most patients with CLL will respond well to ibrutinib (Imbruvica) understanding their mutational status can help inform prognosis, Bociek explains.

Moreover, if patients do not want to receive ibrutinib or fixed-duration venetoclax (Venclexta) and prefer bendamustine plus rituximab (Rituxan) or fludarabine, cyclophosphamide, and rituximab (FCR), getting prognostic testing is critical, says Bociek. However, testing for FISH cytogenetics or IgH status is becoming less important as more novel targeted therapies are introduced to the CLL paradigm. Moreover, these markers could become less relevant in the coming years as minimal residual disease and other molecular or biologic features take on a greater role for prognostication in CLL, concludes Bociek.