Over the course of a year, CLL Society Bloodlinewill teach the BASICS needed to understand CLL. It will provide news, help with the acronyms and new words, and offer simple, fun quizzes.
MONTHLY QUIZ: Having deletion 17p confirms a poor prognosis. Choose all that are correct about this prognostic marker.
- It is detected by “FISH” testing.
- It refers to missing the short arm of the 17th chromosome that should contain the important anti-cancer gene, TP53.
- It is associated with resistance to traditional chemotherapy, but much less so with most novel agents.
- It can lead to increased genetic instability, leading to more mutations.
- It is common at the time of diagnosis, but becomes rarer as the CLL progresses.
Answer: All are true, but the last. Deletion 17p (del 17p) is detected by an important prognostic test called FISH testing (fluorescent in-situ hybridization) that probes the inside of the cells to look for missing or extra genetic material.The short or the petit arm of the 17th chromosome contains P53, a potent anti-cancer gene that has been called the guardian of the genome. P53 tries to repair damaged DNA, and if it can’t repair the damage, it starts the process for the cell to die. Without P53, cells damaged by chemotherapy are not killed, but instead continue to reproduce and may become even more resistant to therapy.Del 17p is only detectable in 5% at diagnosis, but is found in 30% or more at relapse. It can develop without treatment. That is why we recommend FISH testing before starting each line of therapy along with looking at the TP53 gene itself for mutations through next generation sequencing. TEST BEFORE TREAT™ is our mantra.
News:
- Join CLL Society for our next virtual event on March 6, Ask Me Anything: Featuring Dr. Ryan Jacobs and Doreen Zetterlund.
- Save the date! CLL Society’s Celebrating Long Lives 5K will take place during Blood Cancer Awareness Month in September. The new event date is Saturday, September 26, 2026.
- If you missed our webinar, ASH 2025 Comes to You! Watch the replay, and review the presentation slides and transcript.
- The Expert Access Program™ is available to anyone with a CLL diagnosis residing in the US. It is a free and easy way to receive a 2nd opinion from a CLL expert physician, through a HIPAA-compliant telehealth appointment. Participants can reapply if they are unsure of their disease status or treatment plan.
THE BASICS: When is treatment needed? The decision to start treatment should never be based on blood counts alone, but by looking at the whole patient. Consider initiating therapy when there is the presence of:
- B Symptoms
- Weight loss >10% of body weight in previous 6 months
- Severe fatigue (ambulatory and capable of all self-care but unable to carry out any work activities)
- Fevers >38°C (100.4°F) for at least 2 weeks without evidence of infection
- Drenching night sweats for more than a month without evidence of infection
- Evidence of progressive bone marrow failure manifest by low blood counts (cytopenias), including anemia (low red blood cells) or thrombocytopenia (low platelets)
- Massive or symptomatic splenomegaly (enlarged spleen)
- Massive or symptomatic lymph nodes or clusters of nodes (>10 cm)
- Autoimmune Hemolytic Anemia (AIHA: body attacks its own red cells) and/or Immune Thrombocytopenic Purpura (ITP: body attacks its own platelets) that is unresponsive to steroids or other standard therapy
- Rising absolute lymphocyte count (ALC) with an increase of more than 50% over a 2-month period or a lymphocyte doubling time (LDT) <6 months. If ALC is <30,000, LDT should not be used as the only criterion for beginning to treat. Remember that there is no lymphocyte count alone that says it’s time to treat.
WORD/ACRONYM OF THE MONTH: Progression Free Survival (PFS) refers to how long one’s CLL does not progress with therapy. It’s a commonly used endpoint in clinical trials. Progression with a rising ALC or swelling nodes doesn’t mean treatment is needed, as noted above. Time to Next Treatment (TTNT) is a newer endpoint that might be more helpful.
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