Identifying the Worst of the Worst and How Best to Treat Them

Mark G. Frattini, MD, PhD
December 6, 2010

In patients with CLL, Dr. Stephan Stilgenbauer from the University of Ulm in Ulm, Germany, described the ultra high-risk group as those with an expected overall survival of less than two to three years, patients with a chromosome 17p deletion or sole p53 mutation without 17p deletion, patients who are purine analog (i.e., fludarabine or pentostatin) refractory, and lastly those with only a 24- to 36-month remission duration following intensive therapy (e.g., FCR-fludarabine, cyclophosphamide, and rituximab). He stressed the need to treat these patients first-line on a clinical trial with novel agents. In addition, a consolidation strategy including either reduced-intensity allogeneic stem cell transplantation or clinical trial with novel agents should be considered depending on patient age and performance status. In the absence of a clinical trial with novel agents, immunotherapy with ofatumumab or alemtuzumab or other chemoimmunotherapy could be used.