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ASH 2018: Professor Hoffbrand on 50 years of treating CLL (chronic lymphocytic leukemia)

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Dr. Victor Hoffbrand, Emeritus Professor of Haematology at University College, London, is a legendary hematologist, educator, writer, editor, and researcher who has his own Wikipedia page and is the lead author of Hoffbrand’s Essential Haematology, the best-selling hematology text in history.

It was an honor to be able to sit down with him and hear his unique perspective over have a century of managing CLL.

Takeaways:

  • 50 years ago 90% of patients presented with symptoms and about only 10% were found incidentally on an unrelated blood test.
  • Today with more frequent blood testing, the numbers are reversed with only 10% of chronic lymphocytic leukemia patients presenting with symptoms.
  • CLL was hard to research before modern gene sequencing as it divided slowly and was to get genetic information.
  • The watch and wait strategy was developed when a famous study demonstrated no benefit to early intervention with chlorambucil in CLL, the best treatment available at the time. This contributed to the admonition to treat the patient, not the lab results, still the back bone of good therapy.
  • Knowing when to treat patients is one of the most important advances in CLL.
  • The move to combination therapies was slow at first as it was thought best to keep some drugs in reserve.
  • When it finally happened, the evolution to combinations of chemo-immunotherapy such as FCR vastly improved outcomes and the hope is that non-chemo combos will do the same.
  • Until recently there were no good options for relapsed/refractory patients or those with 17 p del.
  • Treatments and outcomes are so much better these days for all patients.

Please enjoy my interview with this remarkable hematologist. I sure did. His metaphor about flowers and weeds is not to be missed.