The 7th Practical Course for the Knowledge and Treatment of Chronic Lymphocytic Leukemia (CLL), organized by the Spanish Chronic Lymphocytic Leukemia Group (GELLC), from Spanish Society of Hematology and Hemotherapy (SEHH)has brought together hematology professionals from all over the country at the Palacio de la Magdalena, in Santander, to review the most relevant advances in a disease that continues to require an individualized approach, sustained attention over time and careful clinical communication.
The role of the hematologist in a chronic disease
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“We are the first to identify the disease in the laboratory and those of us who accompany the patient for years,” says Francesc Bosch, president of the GELLC and head of the Hematology and Hemotherapy Service at the Vall d’Hebron University Hospital, in Barcelona. This continuity of care It is essential in a pathology whose course can be very variable.
For her part, Lucrecia Yáñez, vice president of the GELLC and hematologist at the Marqués de Valdecilla University Hospital, remembers that the “neighborhood” of the bone marrow and lymph nodes determines tumor evolution: “The microenvironment favors the survival of leukemic cells, enhances their resistance to treatments and contributes to immunosuppression of the patient.”
The challenges of clinical communication
The first barrier appears with the word leukemia. “Although CLL may have a slow course, the initial emotional impact is enormous“explains Dr. Yáñez. An added difficulty is the watch and wait strategy, which can be counterintuitive for someone who receives a cancer diagnosis: “We must convey that observing is not ‘doing nothing’but the safest option in many cases.”
Therapeutic indications have not changed in the last decade and continue to be based on clinical and analytical criteria. “More than 40% of patients will never need treatment, and the key is a close monitoringwith a good history and physical examination,” recalls Dr. Yáñez.
In cases of relapse or refractoriness, Dr. Bosch highlights that “the approach must be personalized“, resorting to already known schemes to options such as non-covalent BTK inhibitors, BTK degraders, bispecific antibodies or cellular therapies. Resistance, adds Dr. Yáñez, originates in mutations that allow cells to “evade” the effect of the druga phenomenon that could be reduced with combinations of limited duration.
Respiratory infections: the main threat
During the 2023-2024 season, one in ten cases in the international EPICOVIDEHA-EPIFLUEHA registry corresponded to patients with CLL. “The morbidity and mortality associated with respiratory viruses such as flu, COVID, RSV or pneumococcus It forces us to insist on the vaccination schedule and its annual update,” emphasizes Dr. Yáñez.
Dr. Bosch highlights the emerging role of artificial intelligence in the management of the LLC: “It will allow us integrate genetic, analytical and imaging information to refine the forecast and anticipate risks. Even so, clinical consultation will continue to be irreplaceable.”
