What affects CLL prognosis?

So what will affect the prognosis is a little bit of how the disease already presented itself. So some of these mutations or some of these characteristics will come from the get go, and there's not much you can do about it. From the way therapies are assigned today, there's not too much difference on the sequencing of which drugs used before or after. But at the same time, we have to be careful. So, for example, today we're using less and less chemotherapy. We know they are less effective. So if you end up using chemotherapy, you may impact your marrow reserve. You may not have as much marrow reserved for later on when you need more therapy. So that could impact how the disease, how the prognosis of how the disease will unfold over time. It's not wrong therapies, but treating the disease earlier probably is not going to make a big difference in the long run. But the want to expose patients to treatment when they don't need it. So that can also impact your prognosis. But in general, it's the disease is there making sure that you get treatment when you need. And I think that's one of the most important things that is it is ignoring or denying the disease. Some patients that have been with CLL for so long. It’s been like literally ten, 15 years and eventually say, okay, the time has come. Now we have to treat. It's like really? Do we really have to treat? So then the time when you really have a clear indication for therapy and you don't treat, then you're just setting yourself for trouble. Setting yourself to really allow the disease to give more problems. There are, you know, what we call categories of risks in CLL. Traditionally before will be the staging of these at the time of presentation, we call the Rai stage or the Binet stage system. But I would say the most relevant one will be the molecular and genetic characteristic of the cancer cell itself, the CLL itself, not the patient's cells, which is always a confusion with the patients. So there are alterations regarding to the deletion of chromosome areas, typically the p53 and something called a 70p deletion that deals to, you know, has to do with apoptosis or death of the cells and they get deleted. So those patients traditionally tend to these are what we call our predictive type of parameters where we use at the time of treatment those patients will have these deletions are better served with agents such as BTK inhibitors. There's abnormality in the chromosome. We see something called 11Q deletion and also the mutational status of these immunoglobulin heavy gene regions. So as I mentioned, the patient, the ultimate goal of our patients who want, you know, the normal lymphocytes of plasma cells to produce an antibody. And, you know, they should be mutated so they can react against all the environmental things such as virus, the bacteria. If patients are not mutated, they tend to be at a higher risk of progression. Although with novel agents, these things are becoming less, less, kind of like impactful in the prognosis of these patients.