2020 EHA Courier-Lymphoma Microclass: Changes in prognostic biomarker detection and treatment selection for Patients with CLL before and after the approval of the new drug.

Hello, everyone. Welcome to lymphoma micro class.I am Dr. Luo Jun, Department of Hematology, the First Affiliated Hospital of Guangxi Medical University.today, I would like to share with you a post about the detection of high-risk factors for chronic lymphoblastic leukemia (CLL) published on the 2020 EHA. This study makes statistical analysis on the detection of prognostic biomarkers and treatment options of patients with CLL before and after the approval of new drugs.first, let's look at the background of this study. Randomized studies have shown that new drugs can improve the prognosis of patients with CLL compared with chemotherapy and immunotherapy, especially for high-risk patients (such as del [17p], del [11q], IGHV without mutation, TP53 mutation).therefore, the detection of prognostic biomarkers is an important tool to determine the optimal treatment decision.therefore, this study evaluated the following three aspects: the detection rate of biomarkers before and after the new drug was approved; the proportion of patients who received multiple biomarker tests after the new drug was approved; and the treatment plan of patients without biomarker test after the new drug was approved. Let's take a look at the research method of this study, and before the new drug was approved, it was treated in 2010-2014 The observational registration study, also known as the connect CLL study, was conducted in patients treated with the treatment, and the published detection rate was used as the data source.after the new drug was approved, the detection rate data were obtained from a prospective, observational registration study of American patients receiving CLL treatment since 2015, that is, the informcll study (the data of this study is up to November 2018).the baseline biomarker detection rates before and after the new drug approval were evaluated, including fish detection of chromosomal abnormalities, secondary sequencing to determine IGHV high mutation and TP53 mutation.in addition, the overlap rate of different biomarker tests after the new drug was approved was evaluated, and the treatment options of patients who did not receive the prognosis test were also reported.What are the results of this study? The first is the detection rate of biomarkers. The research data show that before the approval of new drugs, the reported detection rate of biomarkers is 49-58%.in contrast, 361 out of 1181 new drugs were tested, 704 were not tested, the detection rate was 31%, 60% of patients were not tested, and 10% of patients had no data available.among 361 patients tested, fish was the most commonly used test, and 95% of the patients (343 / 361) received the test; and a total of 56 patients, 16% (56 / 361) received all three tests.among the patients who received TP53 or IGHV test, 4% (5 / 124 cases) and 12% (15 / 127 cases) did not receive fish test, respectively.among the patients with positive del (17p), 35% (30 / 86) received TP53 mutation detection; among patients without del (17p), 30% (67 / 226) underwent TP53 mutation detection.in terms of treatment choice, the most common treatment choice for patients who did not receive fish, TP53 or IGHV test was ibutilib (41-42%), and chemotherapy or immunotherapy (52-53%).overall, this study shows that since the approval of ibutinib and other new drugs, the proportion of routine prognostic biomarkers in clinical practice has decreased, and about two-thirds of patients have not received any tests.therefore, the risk status of these patients who were not tested was unknown, and about 40% of them received ibutilib.about half of the undetected patients received chemotherapy and / or immunotherapy, which was associated with reduced survival in patients at high risk.missing the opportunity to choose appropriate treatment may lead to poor prognosis.in high-risk CLL patients who have not been tested for prognosis, ibuprotinib treatment can improve the prognosis. These patients receiving chemotherapy and / or immunotherapy are associated with lower survival rate.this is the end of this [lymphoma micro lecture]. Thank you for watching.med-onc-cn-1318. References: Anthony Mato, et al. Diagnostic biomarker testing and treatment selection in patients with chronic lymphocytic leukemia pre - and post approval of new agents. 2020 EHA. Abstract: ep712. Stamp "read the original", let's make progress together