Highlights from Dr. Keating

One of the traditions of the CLL Global Foundations is to hold two CLL Alliance Meetings each year. During these meetings, 25-30 of the real experts in CLL from around the world, including the United States, Europe, Australia and Israel, come together to discuss new initiatives in CLL. 

One aspect that sets this meeting apart from others is that there is a refreshing openness to share unpublished new data with our colleagues without fear that someone may utilize their discoveries for their own career 

As most of you know, CLL is at a transition point with multiple new therapies that are very specific for the CLL cells and that do not cause damage to the DNA of other cells or significant suppression of the immune system.  These agents, such as ibrutinib (Imbruvica) and idelalisib (Zydelig), are revolutionizing the way we treat advanced patients with CLL who have been treated before, and, more recently, clinical trials are being conducted in previously untreated patients over the age of 65.  This will inevitably lead to approval of these agents as frontline treatment for CLL with a high probability that over 95% of the patients will respond.  To maximize the benefit that we obtain from the treatment we are now able to identify which patients are likely to respond best and longest and which patients might not respond through use of traditional genetic analyses such as cytogenetics, FISH, mutation status, and whole exome sequencing. 

A great advance is that many of our patients, who are elderly and have other coexisting illnesses (comorbidities), are able to be well controlled with the oral agents.  For younger patients (those <75 years of age) the approach is to reduce the bulk of the tumor (debulking) followed by removal of remaining cells (eradication strategy) to render most patients free of detectable leukemic cells in a relatively short period of time, such as 6-12 months.   We already have information that a third of patients that are less than 75 years of age can be effectively cured by the FCR program, yet only the subset of patients with the mutated IGVH gene benefit in this way.  Translating some of the information that we have gleaned from other genetic subtypes will allow us to focus on not only prolonging the patient's life but dramatically improving the quality of life.  The responsibility now is to develop these new strategies as quickly as possible so that the most people can benefit.  Unfortunately this occurs at a time when funding for grants from the National Cancer Institute, American Cancer Society, Leukemia & Lymphoma society, etc. is at a low level with only 7% of grants being funded.  Thus, we come to rely on one the characteristics that set America apart from the rest of the world, namely philanthropy which provides the resources for independent investigational grants. 

For the first time ever, the American Society of

Clinical Oncology has named a "cancer advance of the year". The honor recognizes remarkable improvements in the treatment of CLL. In just over 12 months, four new therapies, with fewer side effects compared to the standard therapy, have been introduced to CLL patients. The new therapies fill a previously unmet need, providing more options for many older patients, and for patients who are newly-diagnosed or who have resistant disease. You can read the full press