ASH 2017: Dr. Dearden on the Progress and Remaining Unmet Needs in CLL (chronic lymphocytic leukemia)

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At ASH (American Society of Hematology Annual Meeting) in Dec. 2017 in Atlanta, Georgia, I re-interviewed one of the nicest CLL doctors, Dr. Claire Dearden of the Royal Marsden in London, England about the amazing progress made in treating CLL (chronic lymphocytic leukemia) in the last five years.

But there are still many unmet needs.

Take Away Points:

• New effective therapies are now available to treat groups of patients whose CLL, until recently, was very difficult to treat, including those that:
  • Have co-morbidities.
  • Are elderly.
  • Have high risk features.
• Chemo-free combinations of targeted therapies are the future of treatment in chronic lymphocytic leukemia.
• Some combinations, such as venetoclax and rituximab, have proven in trials to be better than chemo-immunotherapy. For more information, read fellow Brit, Dr. Follows’ take on the MURANO trial here.
• Dearden says: “perhaps at the next ASH or the next ASH, we won’t be talking much about monotherapy.”
• The ability to stop therapy, as is already being done in CML (chronic myelogenous leukemia), should also be a goal in CLL.
  • It may decrease the risk of developing resistance.
  • It lowers cost for the patient and for society.
  • It reduces side effect risk.
  • For many patients, there is a strong appeal to discontinue taking cancer meds on a daily basis.
• The role of MRD negativity with the novel therapies is still emerging. Here is a link to a debate between Drs. Furman and Davids on its importance.
• Due to the potency of new drugs and the ineffectiveness of old school chemo-immunotherapy in patients with TP53 abnormalities found on the short arm of the 17^th chromosome (17p deletion), it is critical to test for these prognostic factors with FISH and “next gen” sequencing, before each and every treatment as the test results can change over time. Test before Treat is our motto.

Conclusions:

CLL therapy is continuing to rapidly change and improve. New less toxic but powerful oral therapies, more potent antibodies, and more clinically relevant prognostic testing are already here. Non-chemo combinations, cellular therapies such as CAR-T and limited duration of therapy are some of the positive changes we should be seeing more of soon.

Here is our wide-ranging interview from the first day of ASH 2017 in snowy Atlanta, Dec. 2017. You can also read the transcript here.

Stay strong.

We are all in this together.

Brian Koffman, MD  5/15/18