VJHemOnc - new interactive CLL case study w transcript

[db601]

vjhemonc.com/feature/vj-in-...

[Walkingtall62]

Seriously? Maybe me and although I recognise the letters I don’t understand a word. Plus I never open a link someone just sends these days. Sorry to ask, but could you please explain. Thanks

[bennevisplace]

Thanks for posting, although a few words of introduction before the web-link are aways helpful.

I assume that this 12 minute video is for specialist consumption. It's good stuff, from both Sanam Longhavi and Matthew Davids. Their exchange whistles through CLL diagnosis, monitoring and treatment/ retreatment options for a high risk patient with del (17p), IGHV unmutated, and is definitely worth a look for those wishing to galvanise their knowledge.

The transcript contains what I believe is a misleading typo: color for collar. At ~3:50, SL starts talking about a "variant collar", evidently a de minimis value, below which the presence of a subvariant would not be reported by the lab. The proposed/ standard treatment might eliminate TP53 (wild-type) but inadvertently select for an unreported subvariant TP53 (mutated).

Dr Davids is clear that for most high risk patients, the first-line treatment he would choose is a second generation BTK inhibitor, i.e. Acalabrutinib or Zanubrutinib. For patients with exisiting cardiovascular issues, as in this case, the safer choice would probably be Venetoclax + Obinutuzumab. Although the latter therapy is likely to provide a shorter remission than the former, it does offer the prospect of Venetoclax retreatment.

[CycleWonder in reply to bennevisplace]

Thank you for your summary!

[Skyshark in reply to bennevisplace]

It is color (colour). The flow cytometry (FC) process uses a number of coloured dyes. So you will see things like FC 4 colour, FC 6 colour and FC 10 colour in trials reports. The more colours the more sensitive the testing.

They didn't make it clear that CD5- is a key indication of Atypical CLL but did discus some ways of differentiating it from MCL (mantle cell) and MZL (marginal zone). The table presented is only for CD5+ (typical CLL). About 10% of CLL patients are Atypical.

The CLL medical profession still don't seem to have picked up on the results from CLL14, CAPTIVATE FD and ELEVATE TN that all show a much better result for mutated IgHV with TP53 aberrations than for unmutated IgHV with TP53ab. Because of this unmutated IgHV with TP53ab do unexpectedly worse than the overall results presented for TP53ab on all regimes. Only 20%-30% of patients with TP53 aberrations are IgHV mutated and are less than 7% of CLL patients.

[bennevisplace in reply to Skyshark]

Aha. The word collar, as in cap and collar, to me made sense in this context, while the word color did not. Now it does! Thank you sir.

[SofiaDeo]

It's actually a requirement here to post a brief intro or summary.

Guideline #19:

"If you post a link, please at least explain briefly what people can expect to find if they follow the link. Links without such an introduction/explanation may be deleted."

Please give some information as to what this link is about. And why you are posting/what you are asking.

Not going to click on some random link. Especially in an unlocked post.

[db601]

My apologies for not giving a summary. The caption and source is self evident. I thought it more important to share the timeliness of what is available in the international community.

The heading was an alert to our forum of a new posting by VJHemOnc. *I was not asking a question*.

Thank you to the well informed members who kindly summarized the transcript. My second read was so much clearer with your help.