Dr. Danilov on the Role of Disease Biology in Up-front Treatment Selection in CLL

Alexey V. Danilov, MD, PhD, associate professor of medicine, Program in Molecular and Cellular Biology, Cancer Biology Graduate Program, Oregon Health & Science University School of Medicine, discusses the role of disease biology in up-front treatment selection in chronic lymphocytic leukemia (CLL).

The frontline treatment paradigm has shifted significantly with the introduction of new therapies in CLL, says Danilov. As such, disease biology should be considered when selecting up-front treatment.

For example, all patients should undergo fluorescence in situ hybridization to identify any abnormalities, Danilov explains.

Additionally, next-generation sequencing should be considered to identify genetic mutations, including TP53, NOTCH1, and SF3B1 mutations, says Danilov. The presence of these mutations indicates inferior prognosis for patients with CLL.

Although IGHV mutational status is becoming less relevant among novel therapies, IGHV is prognostic with certain agents, such as venetoclax (Venclexta) per the updated CLL14 trial results, concludes Danilov.