A Patient-Centered Approach: Treatment Strategies for Progression and Intolerance in R/R CLL - Episode 2
Timing of Treatment Initiation in Relapsed CLL: Factoring in Prognostic and Patient Factors
Panelists discuss how they approach prognostic marker testing at relapse, the importance of ruling out Richter's transformation, and timing of treatment initiation based on disease characteristics and progression patterns.
Prognostic Marker Testing and Treatment Timing at Relapse
The discussion focuses on the optimal timing for prognostic marker testing in CLL patients at first relapse. Experts recommend checking prognostic markers immediately upon progressive disease, including TP53 mutations, deletion 17p, and karyotype analysis, as these results influence both current treatment decisions and future therapy sequencing.
For patients with newly acquired high-risk mutations like deletion 17p and TP53 alterations, the approach to treatment initiation may be more aggressive compared to standard practices. While typical CLL management involves waiting for symptom development before starting therapy, high-risk genomic features may warrant earlier intervention due to potentially rapid disease progression.
The segment emphasizes the importance of monitoring disease kinetics, including lymphocyte doubling time and growth rate of lymphadenopathy, particularly in high-risk patients. This information helps clinicians distinguish between patients who can safely observe progression versus those requiring immediate treatment initiation, especially given the poor prognosis associated with deletion 17p and TP53 mutations in the relapsed setting.
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