expert remarks: Benefit of prognostic testing in CLL

[Guest guest]

Copying expert remarks:

Benefit of prognostic testing?

I do want to re-emphasize what has already been mentioned because I do

believe it to be a very important point.

While prognostic markers have taught us a great deal regarding the biology

of CLL, it has very limited use in clinical practice at this time. The most

important thing to remember regarding any prognostic testing (and the

application of such to a population) is that it can only tell you which

curve you are on, it cannot tell you where on the curve you will be.

This is important, as some patients with good prognostic markers will need

treatment before patients with bad prognostic markers. They thus serve to

cause worry and angst.

Some patients will like to know their prognostic markers so they can plan

for the future. There is no greater means for predicting the need for

treatment than following the rate of disease progression. It is my hope (and

I am sure everyone else's) that soon everyone will be able to take advantage

of all of the new agents that are very effective (CAL-101, PCI-32765, R788,

etc.).

The two exceptions are 17p deletions and 11q deletions. These two iFISH

abnormalities have significant implications for choosing therapies. 17p

deleted patients tend to not respond well to purine analog and alkylator

based treatments and 11q deleted patients do markedly better with FCR

compared with FR.

There is a potential for prognostic markers to help guide how we decide when

to initiate therapy. Patients with poor prognostic markers might benefit

from early initiation of therapy. This concept was being tested in a

cooperative group trial that closed secondary to poor accrual. There is

European study that has completed accrual that we are waiting on data from.

But in the meantime...all is as above.

To end with a quote from Sir Arthur Conan Doyle(from the 2010 ASH CLL

Education Session):

" While the individual man is an insoluble puzzle, in the aggregate he

becomes a mathematical certainty. You can, for example, never foretell what

any one man will be up to, but you can say with precision what a number will

be up to. So says the statistician. "

RF, MD