Molecular Genetics and Prognosis in Younger Patients with CLL

[Jm954]

While CLL is commonly diagnosed in older patients, there are ~15% of patients diagnosed at ages younger than 50. Several past studies have investigated differences in clinical parameters and treatment outcomes in younger patients with CLL, including a shorter time to first treatment (TTFT) among younger patients (Parikh et al. 2014).

However, few studies have reported on the genetic mutational differences between younger and older cohorts. To bridge this gap, we investigated the mutational landscape between younger and older patients and evaluated the clinical outcome TTFT, hypothesizing that our younger cohort of patients would associate with higher risk lesions and behave more aggressively.

The good news is that they found that younger patients have a longer TTFT, which is contrary to previous studies that have identified younger age as a negative prognostic marker. Future research is needed to determine why younger patients in our cohort appear to have a more indolent disease course in terms of TTFT despite similar baseline prognostic factors and molecular genetics to older patients.

More details here: ash.confex.com/ash/2019/web...

Jackie

[Newdawn Administrator]

This is very encouraging news for our younger members in terms of time to first treatment;

‘There was a longer TTFT in younger patients with a median TTFT of 7.61 years compared to 4.42 years in older patients’.

I was slightly older than 50 at dx (54) but had 7 yrs to first treatment which is ongoing. Issue now are comparative survival statistics! 🥴

Newdawn

[db601]

Thank you.

Question - ***the ATM mutation***

I have a cousin dealing with the EGFR mutation. She has a lung cancer met to vertebrae. The therapy - just started - has been the target drug ***Tagrisso***

Genetic counseling associated the ATM mutation with her EGFR mutation.

I read the abstract you linked with the chart and did not see a mention of EGFR. I understand it is probably a facet of both mutations (not sure I am using the correct language).

***Should CLL patients be tested for EGFR? ***

Secondary cancers - I think- are the cause of most deaths in CLL patients.

Thanks for any clarity you may offer.

~ Diana

PS

I have just had a Chromophobe RCC (renal cell carcinoma)(under 2 cm) removed from my kidney. No nephrectomy needed. No treatment. Wide margins clear. Found by accident on a CT abdominal.

The geneticist want to test the tumor for EGFR. The surgical team insists - no testing is needed. The fighting never ends. I will get it done but geeeeez ... this is my 4 th rodeo with cancer.

I am on Ibrutinib for 5 years. 11q mutated.

It may be the culprit.

[Newdawn Administrator]

Not strictly true it would seem Scott.

‘EGFR is mutated in 1.8% of non-hodgkin lymphoma patients with EGFR Mutation present in 1.8% of all non-hodgkin lymphoma patients [4].

EGFR Mutation is an inclusion criterion in 4 clinical trials for non-hodgkin lymphoma, of which 4 are open and 0 are closed. Of the trials that contain EGFR Mutation and non-hodgkin lymphoma as inclusion criteria, 1 is phase 1 (1 open) and 3 are phase 2 (3 open) [5].

Pi3k/mtor inhibitor ly3023414, olaparib, and palbociclib are the most frequent therapies in trials for non-hodgkin lymphoma that contain EGFR Mutation [5].’

mycancergenome.org/content/...

Newdawn

[db601 in reply to Newdawn]

This link and discussion are very much appreciated. You are helping to *arm* my arsenal. I’m getting my post op strength back with diet and exercise and will soon take on the next challenge.

Geneticists vs Surgeon

*Yes, the tumor needs to be tested. *

*No, it’s not necessary. *

I’ve offered to pay.

Thank you for the link, discussion & support.

~ Diana

[Newdawn Administrator]

In fairness it doesn’t differentiate between types of NHL’s so I don’t know of the incidence in CLL. It’s not routinely discussed on here as you say but we rarely seem to totally dodge these nasties!

Newdawn