Dr. Stephan Stilgenbauer out of the University of Ulm is one of the top researchers of chronic lymphocytic leukemia (CLL) in Germany where there have been several breakthroughs in our understanding of CLL.
In this interview, Dr. Stilgenbauer discusses clonal evolution at the American Society of Hematology annual meeting in December 2015 in Orlando.
TAKE AWAY POINTS:
- CLL is a dynamic disease that evolves over time with new mutations.
- Certain mutations drive the disease process, while others are less important. We only worry about “driver” mutations.
- Therapy put pressure on certain sensitive clones, but not on some others that after treatment and relapse may emerge as dominant and are often more difficult to treat.
- Mutations may occur even when there has been no treatment.
- During treatment with novel therapies, mutations may develop that can lead to resistance.
- It is critical to test or retest your CLL before starting any new therapy.
Unlike in the USA, in Germany treatment is more standardized, done by coalitions of leading researchers, and often involves clinical trials. Very large cohorts are needed over long periods of time to do this type of research.
Here is a link to the actual ASH abstract that he explains.
Here is my interview with Dr. Stephan Stilgenbauer.
For some background on this area, take a look at our Beyond the Basics section on clonal heterogeneity and my interviews with Dr. Catherine Wu.
If you want to read more about clonal evolution, here is a link to abstract of an article published in Blood in 2016 and here is another full article on genomic and epigenomic (how the genetic information is turned on or off) heterogeneity in chronic lymphocytic leukemia from the journal, Blood in 2015 co-authored by Dr. Wu.
This is a hot topic, as we need to understand it to overcome disease resistance and prevent relapses and disease progression.
Brian Koffman, MD 2/29/16