iwCLL 2013: Dr. Jeff Sharman Discusses New Prognostic Factors and Pharmacogenetics

In this interview with Dr. Jeff Sharman, a very clear teacher and community based cancer researcher, we learn about what I call the coming third generation of prognostic testing.
The first generation was staging, Rai in the USA, Binet in Europe, plus what the more marrow looked liked (degree and pattern of infiltration), and some simple tests such as monitoring  the rate of the rise in the lymphocyte count (doubling time), and B2M, a marker of disease burden.
Then we got more sophisticated with FISH testing, ZAP 70, and mutation status.
Dr. Sharman tells us what is coming next. An abstract of the Blood article that reviews some of this topic can be found here.
And the progress is not stopping.
Here's a new word we should learn: pharmacogenetics, our unique genetic nature or phenotype concerning how we metabolize medications. As we might easily infer,  our individual  pharmacogenetics has significant consequences on how well we respond to some therapies.
An article published last month in Blood, describes for the first time how our genetic make up, specifically the subtype or allele of CYP2B6 that we carry, determines how well we convert a certain chemotherapeutic agent, in this case cyclophosphamide into its active form which in turn influences our response to that chemo.  Not unexpectedly, those who have a low conversion rate not only do more poorly, but also have less adverse toxic events.
This is a whole new area of medicine, pharmacogenomics, that is already important in cardiac disease where we can measure markers that tells us how and when we doctors should but sadly too often are not, properly using certain blood thinners based on the patient's measurable genetic make-up.