A patient’s IGHV mutation status is a key factor in CLL prognosis. Doctors looking for a patient’s IGHV mutation status are looking at the age of the cell that allowed CLL to grow. If it is a younger, unmutated cell, it will likely be more aggressive. If it is an older, mutated cell, those tend to be slow-growing.
This information helps doctors determine which type of treatment to use. Typically, a patient with a mutated IGHV cell will go into remission for 10 to 15 years after initial treatment while a patient with an unmutated cell will typically only have 3 to 4 years of remission.
Read More Dr. Matthew Davids, associate director of the CLL Center at Dana-Farber Cancer Institute, says newer drugs such as Ibrutinib, Idelalisib and Venetoclax tend to be more effective at treating un-mutated IGHV cells and offer some promise for the future. According to the National Comprehensive Cancer Network guidelines, ibrutinib (Imbruvica) and acalabrutinib (Calquence) with/without obinutuzumab (Gazyva) are the preferred first treatment for all patients including high risk subgroups such as unmutated IGHV. Fludarabine, Cytoxan and Rituxan (known as FCR) is the preferred treatment for patients under 65 years old with untreated IGHV-mutated CLL, according to NCCN.
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