@article{08453017f4584e16a74daa4269e109bb,
title = "Prognostic Testing Patterns and Outcomes of Chronic Lymphocytic Leukemia Patients Stratified by Fluorescence In Situ Hybridization/Cytogenetics: A Real-world Clinical Experience in the Connect CLL Registry",
abstract = "Prognostic genetic testing can guide treatment decisions and predict outcomes for patients with chronic lymphocytic leukemia (CLL). Among 1494 patients with CLL treated in the community setting, prognostic genetic testing was infrequently performed and the outcomes were inferior for patients with unfavorable-risk disease. This highlights the importance of prognostic testing for patients with CLL to guide treatment and improve outcomes. Introduction: Prognostic genetic testing is recommended for patients with chronic lymphocytic leukemia (CLL) to guide clinical management. Specific abnormalities, such as del(17p), del(11q), and unmutated IgHV, can predict the depth and durability of the response to CLL therapy. Patients and Methods: In the present analysis of the Connect CLL Registry (ClinicalTrials.gov identifier, NCT01081015), a prospective observational cohort study of patients treated across 199 centers, the patterns of prognostic testing and outcomes of patients with unfavorable-risk genetics were analyzed. From 2010 to 2014, 1494 treated patients were enrolled in the registry by line of therapy (LOT), and stratified by the results of cytogenetic/fluorescence in situ hybridization (FISH) testing into 3 risk levels: unfavorable (presence of del[17p] or del[11q]), favorable (absence of del[17p] and del[11q]), and unknown. Results: Cytogenetic/FISH testing was performed in 861 patients (58%) at enrollment; only 40% of these patients were retested before starting a subsequent LOT. Of those enrolled at the first LOT, unfavorable-risk patients had inferior event-free survival compared with favorable-risk patients (hazard ratio, 1.60; P =.001). Event-free survival was inferior with bendamustine-containing regimens (P <.0001). Event-free survival did not differ significantly between risk groups for patients treated with ibrutinib or idelalisib in the relapse/refractory setting. The predictors of reduced event-free survival included unfavorable-risk genetics, age ≥ 75 years, race, and treatment choice at enrollment. Conclusion: The present study has shown that prognostic cytogenetic/FISH testing is infrequently performed and that patients with unfavorable-risk genetics treated with immunochemotherapy combinations have worse outcomes. This underscores the importance of performing prognostic genetic testing for all CLL patients to guide treatment.",
keywords = "Community setting, Cytogenetic testing, Kinase inhibitor, Prognosis, Unfavorable risk",
author = "Anthony Mato and Chadi Nabhan and Kay, {Neil E.} and Nicole Lamanna and Kipps, {Thomas J.} and Grinblatt, {David L.} and Flowers, {Christopher R.} and Farber, {Charles M.} and Davids, {Matthew S.} and Pavel Kiselev and Swern, {Arlene S.} and Shriya Bhushan and Kristen Sullivan and Flick, {E. Dawn} and Sharman, {Jeff P.}",
note = "Funding Information: The authors received medical writing support in the preparation of this report from Victoria Edwards, PhD, and Eva Polk, PhD, CMPP, of Excerpta Medica BV, supported by Celgene Corporation. The Connect CLL Scientific Steering Committee acknowledges the contributions of all previous and current members of the Committee for their guidance in the design of the registry and participation in the analysis of the data, including Matthew S. Davids, Charles M. Farber, Ian Flinn, Christopher R. Flowers, David L. Grinblatt, Neil E. Kay, Michael Keating, Thomas J. Kipps, Mark F. Kozloff, Nicole Lamanna, Susan Lerner, Anthony Mato, Chadi Nabhan, Chris L. Pashos, Jeff P. Sharman, and Mark A. Weiss. The Connect CLL Registry is sponsored and funded by Celgene Corporation. All authors directed the development, reviewed, and approved the report and are fully responsible for all content and editorial decisions. Celgene Corporation supported the authors in collecting and analyzing the data reported in this registry. Funding Information: A.M. has received research funding from AbbVie, Celgene Corporation, Gilead, Pronai, and TG Therapeutics; has been a consultant for AbbVie; and has been a member of a speakers{\textquoteright} bureau for Celgene Corporation. C.N. is employed by Cardinal Health Specialty Solutions; has received research funding (2014–07/2016) from Astellas, Celgene Corporation, Genentech, and Seattle Genetics; and has been on advisory boards for AbbVie, Cardinal Health, Celgene Corporation, Genentech, and Infinity. N.E.K. has received research funding from Celgene Corporation, Genentech, Gilead, and Pharmacyclics; and has been on advisory committees for Celgene Corporation and Gilead. N.L. has received research funding from AbbVie, Genentech, Gilead, Infinity, and Pronai; has been a consultant for AbbVie, Genentech, Gilead, Pharmacyclics, and Pronai; and has been on an advisory committee for Celgene Corporation. T.J.K. has received research funding from Celgene Corporation and Roche; has been a consultant for AbbVie, Celgene Corporation, and Pharmacyclics; and has received honoraria from Pharmacyclics. D.L.G. has been a consultant and member of a speakers{\textquoteright} bureau for Celgene Corporation. C.R.F. has received research funding from AbbVie, Acerta, Gilead, Infinity, Janssen, Millennium, Pharmacyclics, Spectrum, and TG Therapeutics; has been a consultant for Celgene Corporation, Genentech/Roche, Gilead, Millennium, Optum Rx, and Seattle Genetics; and has received honoraria from Celgene Corporation. C.M.F. has received research funding from Genentech and Gilead; has been a consultant and part of a speakers{\textquoteright} bureau for Celgene Corporation, Genentech, Gilead, Janssen, Pharmacyclics, and Seattle Genetics; has been on an advisory committee for Celgene Corporation; and has received honoraria from Janssen. M.S.D. has received honoraria from Janssen; has been a consultant for AbbVie, Genentech, Gilead, InCyte, Infinity Pharma, Janssen, Pharmacyclics, and TG Therapeutics; and has received research funding from Genentech, Infinity Pharma, Pharmacyclics, and TG Therapeutics. P.K., A.S.S., S.B., K.S., and E.D.F. are employees of Celgene Corporation and have equity in the company. J.P.S. has received honoraria from Genentech, Gilead, and TG Therapeutics; has been a consultant for Celgene Corporation, Genentech, Gilead, and Pharmacyclics; has been a member of a speakers{\textquoteright} bureau for Gilead; has received research funding from Acerta, Celgene Corporation, Genentech, Gilead, Pharmacyclics, Seattle Genetics, and TG Therapeutics; and has received travel expenses from Celgene Corporation and Gilead. Publisher Copyright: {\textcopyright} 2017 The Authors",
year = "2018",
month = feb,
doi = "10.1016/j.clml.2017.11.010",
language = "English (US)",
volume = "18",
pages = "114--124.e2",
journal = "Clinical Lymphoma",
issn = "2152-2669",
publisher = "Cancer Media Group",
number = "2",
}