Skip to Navigation Skip to Search Skip to Content
Search All Centers

An Expert’s Perspective on Testing for CLL Patients

Read Transcript Download/Print Transcript

Published on November 20, 2019

Key Takeaways

  • Learn the value of individual tests for CLL.
  • Why some tests are more important than others upon diagnosis.
  • What specific test results indicate.

Noted expert Dr. Justin Taylor discusses fundamental things for patients to know when diagnosed with chronic lymphocytic leukemia (CLL), including which tests are critical, which are optional, and what the results help determine. Watch as Dr. Taylor explains the value of specific tests such as a bone marrow biopsy, FISH, mutation analysis, and the Immunoglobulin gene (IGHV—mutated and IGHV—unmutated) test. 

This is a Patient Empowerment Network program produced by Patient Power. We thank AbbVie, Inc. and Pharmacyclics for their support. These organizations have no editorial control.

Featuring

What a wonderful time we had! We were excited like fans at a rock concert, but our rock stars were the medical experts.

— Lynn, CLL town meeting attendee

Partners

Patient Empowerment Network

You might also like

Transcript |

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That's how you’ll get care that's most appropriate for you.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Andrew Schorr:                      

What tests are necessary? So, maybe you could help us understand. If you are out there in the hinterland, and you needed to help yourself as the physician, and the patient just kind of understand what's going on, what’s the basics? So, first, let's start at diagnosis. What's the basics to know what’s going on? Do you have to have a bone marrow biopsy? Do you do CBCs? Do you have to do what we call FISH testing mutational status? What's like the basic?

Dr. Taylor:                   

Yeah. Thanks. And we definitely can do, as Susan was saying, many, many tests with different sensitivities and specificities, but kind of the gold standard of proving whether adding these tests makes the difference is to do a clinical trial or a prospective trial, I guess, where you measure these things before patients get treatment, and then see which of them makes a difference in the outcome.

And when you add them all into a kind of analysis that includes all of these tests, which ones are important of themselves because some tests are markers, basically, of something else that you can measure. So, that being said, there have been many studies like this to try to see whether we can add in any of these new tests that have been developed in the decade to the kind of gold standard. And many times all of the new tests that we add aren't able to distinguish that much more than what the basic tests show, so I...

Andrew Schorr:                      

Okay. So, literally, let’s just tick off some. Bone marrow biopsy; critical to do?

 Dr. Taylor:                   

That’s very controversial. We still do that. I don’t think that it’s critical in making the diagnosis. That could be made from the peripheral blood flow cytometry, which tells you the markers on the surface of the cell, that they’re different than normal B cells. We still do the bone marrow biopsy to get a sense of the stage of the disease, how much CLL there is. But it’s not absolutely required for the diagnosis.

 

Andrew Schorr:                      

Oh, okay. And what about so-called FISH testing; is that important?

Dr. Taylor:                   

I think it’s important, based on what we talked about with the 17p deletion. It can detect that. That’s a big change on the DNA, on the chromosomes, that can be detected by FISH. And, yeah, many of the tests I was referring to before are looking at specific genes. I don’t think that those are necessary. They definitely can give some insight to the treating physician, but. 

Andrew Schorr:                      

Okay. And then the last one is that I always get this backwardsis it IgVH, IvGHbut the mutational status, why is that important?

Dr. Taylor:                  

Yes, the IgHV mutational status, if I got it right, is important because there’sbasically falls into two camps. You can have unmutated and you can have mutated, and you would think that the mutated would the worse, but it’s actually the unmutated that has the worse outcomes.

And that’s important because it’s been shown that this unmutated set of IgHV unmutated CLL may not be the type of patient that you want to give chemotherapy to. They may not respond as well to chemotherapy. That may be something you want to go straight to one of the new agents.

And for the mutated patients, which have a little bit better prognosis, new agents are definitely on the table for them also, but there’s a subset of those patients who, with chemotherapy, a study done at MD Anderson that followed these patients 20 or more years after chemotherapy, a subset of those with IgHV-mutated CLL did not require further treatment. Essentially, we didn’t say that they were cured, but they were as if they were cured. They only got one treatment with chemotherapy and never required anything again.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

You might also like