MONTHLY QUIZ: Choose the correct statement below:
- CLL most commonly presents in men and in the elderly (over 70).
- CLL has two peak incidences: a smaller peak at age 55 and a largest one at age 72.
- CLL is most common in women in their 50s and 60s.
- CLL affects men and women equally.
ANSWER: The correct answer is #1. CLL is more common in men and the average age at diagnosis is 72. It is quite rare but possible for those under 30. About 10% present under 50 and 5% under 40. It is more common in Ashkenazi Jews, less common in Asians.
Finally, some good news on the COVID front. In a population-based study out of Denmark, during the Omicron surge the mortality rate in infected CLL patients was down to 2%. However, those over 70 or those with comorbidities or interestingly, those tested at hospital sites had much higher mortality. Antiviral therapy should be considered for all CLL patients, but especially for this high-risk group.
Join us for CLL Society’s inaugural 5K virtual walk/run event, Celebrating Long Lives, taking place on July 23rd! Registration is now open, learn more here.
Join us for our next webinar focused on BTKi’s with Dr. Matthew Davids on Tuesday, June 28th; registration is here.
THE BASICS: Watch and Wait
The first treatment for most CLL patients is “Watch and Wait” or “Active Observation” or as patients often call it, “Watch and Worry”. It is at first glance one of the most counter-intuitive concepts in CLL management. With many types of cancer early detection is critical with the prognosis getting worse with more advanced stages of the disease. That is the whole philosophy behind regular PAP smears, mammograms, colonoscopies, PSA and skin check: try to catch the cancer early.
But in CLL until a study reported in 2019 that for asymptomatic high-risk patients, early intervention with ibrutinib improved progression free survival and time to next treatment, there were no data showing that earlier treatment at the time of diagnosis helped in any way. There are two main reasons for this lack of benefit:
- Until recently, all treatment options were either relatively toxic or ineffective.
- Some patients will never need treatment so treating early only exposes them to toxicities with no benefits.
Even with the positive trial in 2019, the role for early intervention approach is controversial. Why take a medicine for years that you may never need and has not yet been shown to improve overall survival when taken early? Is taking it when needed just as good? Outside of a clinical trial, watch and wait is still the smart option but more trials are in progress using novel agents in high-risk patients such as those with del 17p.
WORD/ACRONYM OF THE MONTH: FLOW CYTOMETRY
Flow Cytometry is a powerful blood test that looks at markers on the cell surface. It is the test necessary to confirm the diagnosis of CLL by identifying the typical clonal population of cells (CD19, CD20(dim), CD23 and CD5). It is also be used to assess MRD (measurable or minimal residual disease) down to 1 cancer cell in 10,000.