Traditional Definition of ‘High-Risk’ in Patients With CLL and SLL Outdated, Needs to be Revisited


In an interview with CURE®, Dr. Jan A. Burger discusses how the results of two phase 3 studies could help redefine what constitutes as low or high risk in patients with CLL or SLL.

The traditional definition of what makes a patient with chronic lymphocytic leukemia (CLL) or small lymphocytic leukemia (SLL) high-risk needs to be revisited, according to Dr. Jan A. Burger.

Burger discussed this claim as a result of a study of first line Imbruvica (ibrutinib) in patients with CLL/SLL who are considered high-risk that was presented at the ASH Annual Meeting and Exposition. According to Burger, the outcomes of the study are in line with previous studies that have shown patients considered high-risk have had similar outcomes to patients not considered high risk when receiving BTK inhibitors.

In an interview with CURE®, Burger, a hematology oncologist in the Department of Leukemia at MD Anderson Cancer Center, discussed the overall outcome of the analysis and what it means for patients.


Outcome of this analysis was that these high-risk features really don't matter with the BTK inhibitor therapy with ibrutinib-based treatment. High risk patients or all low-risk patients have similar survival outcomes, progression free survival is similar to the low-risk patients and overall response rates are also in the same range. So, I think this is just another piece of the puzzle to come to this conclusion that our traditional definition of high risk CLL has to be revisited. And we have to come to the conclusion that these patients previously labeled as high risk have much better outcome now with BTK inhibitors and those risk factors don't matter as much anymore, now that we are transitioning most patients to these new agents.

Oftentimes patients come and of course, they have the information about what their risk factor profile looks like and patients might be concerned that they have some risk features which put them in a high-risk category. To those patients, I would say with these data, but also with data from other studies which came out recently, is that one of our current standard treatments, which is with the BTK and tyrosine kinase inhibitors, those labels of high-risk patient and inferior survival are becoming outdated. Now that we see that those patients have very good survival outcomes and progression free survival that's similar to match lower risk patients. For that reason, we can tell those patients I think safely to say that their outcome is much better than it used to be when we had only chemotherapy-based treatment or chemo immunotherapy available.

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