del17p CLL? Overall Survival and Progression-Free Survival Are Improved With Ibrutinib

del17p CLL? Overall Survival and Progression-Free Survival Are Improved With Ibrutinib

Ibrutinib treatment for chronic lymphocytic leukemia with the deletion of chromosome 17p (del17p CLL) increases the percentage of patients alive at 30 months over other therapies for del17p CLL, study findings presented at the European Hematology Association 21st Congress have shown: oncologynurseadvisor.com/le...

'This study analyzed data from 243 patients with del17p CLL from 3 different ibrutinib clinical trials. Half of the patients received ibrutinib for 28 months or longer. The overall response rate was 84%. Progression-free survival at 30 months was estimated at 55%, and overall survival was 67% at 30 months.'

Neil

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  • Provided you have CLL, not SLL where there's not enough CLL cells to be detected, a FISH test on a blood sample will show if your CLL cells have 17p deletion genetic damage. With SLL, a FISH test of an enlarged lymph node biopsy may be needed. A FISH test of bone marrow biopsy sample could also show it as you noted.

    Neil

  • Is 17p worked out as a percentage of lymphocytes ,CLL cells or B Lymphocytes? Also, if you had a small percentage say 10% or 20% 17p would FCR still work?

  • Some reports may show percentages; my FISH test didn't. (The test is done on CD19 expressing lymphocytes, i.e. B-cells, which will include a growing percentage of CLL cells as CLL progresses.)

    The problem with older immuno/chemotherapy drugs like FCR is that because 17p-del CLL cells lack the genetic instructions that would normally result in the cell self destructing when damaged by treatment, they selectively survive in a process called clonal evolution. So when remission ends, the patient ends up with a higher percentage of 17p-del CLL cells. This can happen during W&W too, but more slowly, because there's not the selection pressure. This is why it is important to have a FISH test prior to starting therapy, to ensure you don't go through a treatment like FCR that is likely to only give a short remission.

    Neil

  • 17p deleted...really just says you have none or damaged TP53 gene... guardian of the genome...

    You can also not have a 17p deletion and have a mutated or non functional TP53 gene on one or both alleles...

    Some 17p deleted patients, still have some TP53 function on the second allele.

    Its not black or white but shades of grey... and percentages matter a lot.

    Push for a TP53 test, it is not part of FISH, and is hard to get done outside of U.S. research hospitals... but I know a few who have had it run...

    ~chris

  • Scotland are soon to include, if they have not already TP53 mutational testing as part of pre treatment guidelines, let's hope that others follow.

    Nick

  • This is a case of good, but not good enough. If you are in your 40s, you want options that have more than OS of 67% at 30 months. Let's hope science advances.

  • Ignore statistics! I was supposed to be dead in five years. That was 2003. I'm still here.

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