Genomic Testing Before First-Line CLL Therapy

M. Yair Levy, MD, of Texas Oncology–Baylor Charles A. Sammons Cancer Center, explains why risk stratification matters even though targeted therapy is recommended for every patient with chronic lymphocytic leukemia (CLL): expectations and reality need to line up, and treatment goals differ. Before first-line treatment he orders, at minimum, immunoglobulin heavy chain variable region (IGHV) mutation status and a CLL fluorescence in situ hybridization (FISH) panel, plus next-generation sequencing for TP53, because a TP53 mutation and a 17p deletion do not always travel together. Andrew H. Lipsky, MD, of Columbia University Irving Medical Center, says pan-tumor sequencing panels have become more standardized, while IGHV testing and conventional karyotyping remain harder to obtain. He estimates TP53 aberrations in up to 10% of frontline patients, notes that FISH alone misses about a third of them, and says guidelines steer that group toward continuous Bruton tyrosine kinase inhibitor therapy.