Expert hematologist-oncologist Sonali Smith, MD, shares a brief overview of chronic lymphocytic leukemia (CLL), highlighting incidence, prognosis, and molecular subsets.
Sonali M. Smith, MD: Hello, and welcome to this OncLive Peer Exchange®
titled, “Recent Advances in the Treatment of Chronic Lymphocytic Leukemia.” I’m Sonali Smith, chief of the section of hematology-oncology at the University of Chicago [Chicago, Illinois]. I’m joined today, by a panel of experts in chronic lymphocytic leukemia [CLL]. I would like to welcome my esteemed fellow panelists to introduce themselves.
Sameer A. Parikh, MD: Hi, my name is Sameer Parikh. I’m at the Mayo Clinic in Rochester, Minnesota.
Nicole Lamanna, MD: Nicole Lamanna, Columbia University in New York.
Susan M. O’Brien, MD: Hi, Susan O’Brien from the University of California at Irvine.
Ryan W. Jacobs, MD: Hello, Ryan Jacobs, Levine Cancer Institute, in Charlotte, North Carolina.
John N. Allan, MD: Hi, I’m John Allan. I’m coming to you from New York at Weill Cornell [Medicine].
Sonali M. Smith, MD: Today we’re going to cover chronic lymphocytic leukemia, and we’re going to discuss a number of recent updates in the treatment of CLL that were presented at key conferences in 2022. We’ll be discussing the data in the context of guidelines, the treatment landscape, and its impact on clinical practice. Let’s get started on our first topic.
I’m going to start by giving you a small overview of CLL. As most of us know, CLL, or chronic lymphocytic leukemia, is the most common leukemia in the Western world. There are about 21,000 new cases per year, but because of improving survival, there are 200,000 people living with this disease, which forms the basis for considering both short-term and long-term toxicity. The 5-year survival has been steadily improving to the point where about 75% of patients, all comers, can expect to be alive at the 5-year mark.
When it comes to making the diagnosis, this is typically done either through examination of peripheral blood, visually and then peripheral flow, or through a lymph node biopsy. The diagnosis requires an absolute lymphocytosis, [lymphocyte count] of over 5000 [per μL], and patients often have adenopathy as well as splenomegaly. The clinical staging systems have been around for a long time and include both the Rai and the Binet staging system. This gives us an idea of tumor bulk, at least as it reflects both adenopathies as well as cytopenias that are related to the disease. More recently, we have the CLL-IPI [International Prognostic Index], which takes into account some of the biologic factors, including P53 dysregulation as well as beta-2 microglobulin, age, and also the mutation status of the immunoglobulin variable heavy chain gene [IgVH], as well as the clinical stage. By using this CLL-IPI, you get an idea of the 5-year overall survival and often the indication for whether it is time to treat.
Perhaps one of the most important pieces, biologically, that has informed our treatment decision-making over the last several decades, has been the incorporation of FISH [fluorescence in situ hybridization], in which we look for 4 of the most common types of abnormalities, which include deletion 13q, deletion 11q, deletion 17p, or a trisomy 12. The second biologic advance that has occurred is to understand the importance of the mutation status of the immunoglobulin heavy chain. By using these pieces of information, we’re going to talk today about prognosis, treatment, and how some of these factors can influence decision-making.
Transcript edited for clarity.