Risk models and their potential impact on treatment of CLL
| Risk group . | Definition . | Treatment . |
|---|---|---|
| Low | Mutated IGHV, no 11q or 17p deletion, no prior treatment | Conventional treatment based on fitness as per local guidelines |
| High | Unmutated IGHV, 11q deletion, high β2-microglobulin, no highest-risk features | Suitable for FCR alone or in clinical trial treatment with investigational agent in induction or maintenance.Ibrutinib treatment in first line for FCR-ineligible patients or those with unmutated IGHV. Consider allo-SCT later in disease after consideration of risk factors suggesting poor response to novel agents. |
| Highest | TP53 deletion/mutation and indication for treatment, chemoimmunotherapy refractory disease, early relapse (≤24 mo) after FCR (or FCR-like) treatment | Induction with novel agent; consider allogeneic SCT in suitable patients |
| Risk group . | Definition . | Treatment . |
|---|---|---|
| Low | Mutated IGHV, no 11q or 17p deletion, no prior treatment | Conventional treatment based on fitness as per local guidelines |
| High | Unmutated IGHV, 11q deletion, high β2-microglobulin, no highest-risk features | Suitable for FCR alone or in clinical trial treatment with investigational agent in induction or maintenance.Ibrutinib treatment in first line for FCR-ineligible patients or those with unmutated IGHV. Consider allo-SCT later in disease after consideration of risk factors suggesting poor response to novel agents. |
| Highest | TP53 deletion/mutation and indication for treatment, chemoimmunotherapy refractory disease, early relapse (≤24 mo) after FCR (or FCR-like) treatment | Induction with novel agent; consider allogeneic SCT in suitable patients |