Genetic Testing: What Version of CLL Do I Have and How Do I Treat It?

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Topics include: Treatment and Understanding

What mutations do doctors test for in chronic lymphocytic leukemia (CLL) patients? How do the results affect the course of treatment? CLL expert Dr. Jennifer Brown of Dana-Farber Cancer Institute joined Patient Power at the American Society of Hematology (ASH) 2017 annual meeting to discuss what genetic tests are given to CLL patients, and how conditions are categorized and treated based on the results. Tune in to learn more about genetic testing for CLL patients.

This program is a Patient Empowerment Network program produced by Patient Power. We thank AbbVie, Inc. and Genentech for their support.

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Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

Andrew Schorr:

Jennifer, this relates to testing.  He used the term "17p," so help our audience understand a little bit of it.  He talked about mutation.  What are the testing for?  Somebody comes into Dana-Farber, what are you trying to see which—how they—what their version of CLL is?  What are you looking at to make a decision on what treatment you're going to recommend? 

Dr. Brown:

Right. Well, we do a whole panoply of tests as you might imagine, but there are really two central, most important categories of tests.  And so one is the test that Bill mentioned for mutation or deletion of a cancer gene called p53.  That's the target of what's on 17p involved in many other cancers as well, and we know that if that's deleted in the CLL cells it makes them resistant to many of our older therapies or chemoimmunotherapies for example. 

Andrew Schorr:

And FCR would be a bad idea. 

Dr. Brown:

FCR would be a bad idea, and that's saying for sure.  And we've also learned more recently that sometimes there are other ways of affecting that gene through??that we can identify through mutation testing which is a different type of test which is not quite as widespread yet but probably should become more widespread as a way of understanding who has this risk profile, which remains higher risk with the novel agents even though the novel agents are quite effective in the setting of that genetic abnormality.  

Andrew Schorr:

So novel agents, so it used to be sometimes somebody with this 17p, more aggressive CLL, could you even sometimes could talk about transplant as well, right?  So now it seems like you have these medicines that have utility for what used to be the most aggressive CLL that's been fairly effective, right? 

Dr. Brown:

That's right, especially frontline ibrutinib/venetoclax is approved in relapse as well and idelalisib (Zydelig), also the PI3 kinase, all of them have quite a lot of activity in the sending of 17p. 

Andrew Schorr:

Okay.

Dr. Brown:

That being said, after a person has been—had multiple of those therapies with 17p who is fit for a transplant we would still consider it in certain specific cases at our institution. 

Andrew Schorr:

Okay. 

Dr. Brown:

And there is one other genetic test… 

Andrew Schorr:

Yes, please. 

Dr. Brown:

…for therapy selection, which is called the mutation status.  And that's a test that actually looks specifically at the CLL cells themselves and sort of divides them in two categories based on where it looks like the CLL came from in the development of the cell arc. 

Andrew Schorr:

Is one mutated or un—is one better than the other? 

Dr. Brown:

Well, they're a little bit different.  The mutated is slower moving, and so it might be a much longer time until a person needs treatment. 

Andrew Schorr:

So you may have that watch-and-wait period. 

Dr. Brown:

Right, and it might be long.  And then that's the subgroup of patients that can have the very prolonged benefit and possibly cure from the chemoimmunotherapy with FCR.                  

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

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Page last updated on April 13, 2018