SLL and prognostic indicators

I'm reading articles which suggest that the chromosomal abnormalities of SLL are different from CLL, most especially absence of 17p del and prevalence of Trisomy 12. Does anyone know anything about this?

[Cllcanada Top Poster CURE Hero]

There was a rare SLL verses CLL comparison study presented at ASH 2011 by Spanish researchers...

abstracts.hematologylibrary...

Table of comparison...

abstracts.hematologylibrary...

This study indicates a higher percentage of T12 and lower 13q. Also SLL has a bias for IgHV3-21 gene...

lrjournal.com/article/S0145...

ncbi.nlm.nih.gov/pmc/articl...

[Hidden]

Thanks for these.

[fieldmeadow]

I had widespread sll/cll when diagnosed. Am t12 but no d17

Numerous infected lymph nodes but not too large.

Now being treated with FCR

[Hidden in reply to fieldmeadow]

Thanks, fieldmeadow, hope everything's going well. How did you find the things out?

[fieldmeadow in reply to Hidden]

Found these things out through hospital tests.

Enlarged nodes in neck and groin (plus mouth infections) took me to GP who did blood test. Blood test results led to quick hospital appointment ...

[Hidden in reply to fieldmeadow]

Hi fieldmeadow, so you got to know t12 etc from hospital tests. You in UK? I thought only Americans did Fish test?

[Cllcanada Top Poster CURE Hero in reply to Hidden]

FISH tests are sometimes done prior to treatment to clarify if a patient is 17p deleted, and therefore should be streamed for special treatment, clinical trials or perhaps allogenic stem cell transplant... The U.S. tends to do 'blanket' FISH testing in CLL.

[Hidden in reply to Cllcanada]

Thanks CLL, even in UK?

[Cllcanada Top Poster CURE Hero in reply to Hidden]

Sure, the test is done if the doctor feels it is needed, usually prior to treatment.

[zentangle in reply to Cllcanada]

Because they believe you have aggressive case?

[Cllcanada Top Poster CURE Hero]

FISH panels are used CLINICALLY to primarily separate out aggressive 17p deleted and TP53 mutated or dysfunctional patients. These patients respond poorly to standard therapy... I think FISH panels is used far more by knowledgeable CLL doctors than the average oncologist. They understand CLL better and can probably get a better understand of your CLL from these and other tests. Hence you want an experienced doctor.

In the past few years, based on the CLL8 trial, it has been found that 11q patients do well on FCR therapy, so FISH might be used for that as well. The whole thing is an ongoing learning process...

FISH panels have many other uses in clinical trials and the area of research, but this isn't what I'm referring to...

There is also a 'quality of life aspect' some patients feel they need to know their genetic markers, but in fact, we now know that subclones and B cell receptor stereotypes are perhaps equally or more important than FISH. Further, new research indicates CLL has clonal evolution... that things aren't static. FISH markers at diagnosis could be different than at treatment time, and likely different after treatment.

There currently are no clinical tests, for all the new genetics, so even with a FISH test, the whole story remains untold... but this may change in the next year or so.

Dr. Sharman has a number of articles on this...

cll-nhl.com/search/label/CL...

Here is an example of a private lab doing advance prognostic tests...

neogenomics.com/neotype-cll...

And another...

cgimatba.com/matba-for-cllsll/

[zentangle in reply to Cllcanada]

Very helpful information, but are they used in UK?

[Cllcanada Top Poster CURE Hero in reply to zentangle]

Yes, FISH panels are used in the U.K.

More here... from Christie NHS

'There is no evidence that treatment of early CLL improves overall outcome and so FISH testing is recommended only prior to first treatment. Chromosomal abnormalities may develop during disease course and FISH analysis should also be considered prior to subsequent treatments.

FISH tests are not suitable for monitoring remission. Referred samples must be from involved tissue with significant lymphocytosis. Peripheral blood is suitable test material, in most cases. CLL patients suspected of secondary myeloid disease need to be highlighted as they will be handled differently.'

christie.nhs.uk/the-foundat...

and here...

healthunlocked.com/cllsuppo...

[Immie in reply to zentangle]

Hi

I can confirm my partner had FISH prior to commencing FCR treatment 3 years ago, I think they are also routinely done if you are going into a clinical trial. Unfortunately my partner is now 17p del and had an updated FISH last week as part of the screening for a new clinical trial.

see Cllcanada's post TP53 mutated subclones which makes for very interesting reading. we were told no evidence of TP53/17p del in early tests but wonder if, in light of this article, the % was low (< 10% -hence not picked up. CLL treatment and diagnosis has come a long way in 3 years.

[MsLockYourPosts Passed Volunteer]

Secondary myeloid disease? Is that a form of transformation?

[Cllcanada Top Poster CURE Hero]

It can be secondary to CLL. It is called MDS/AML, but only about 1/3 go acute... it seems to be related to some types of treatments.

It was actually Terry Hamblin's area of interest he has a lot about it

mutated-unmuated.blogspot.c...