Professor Francesco Forconi, the University Hospital Southampton (UHS), has been awarded our first Patient Care Pioneer Award. Within this he aims to develop an algorithm in which to identify lower risk patient with CLL who have longer time to first treatment. This aims to reducing unnecessary clinical interventions, easing patient anxiety, and lessening the strain on healthcare resources.

The Challenge

Chronic lymphocytic leukaemia (CLL) is the most common blood cancer in adults, often requiring long-term specialist monitoring, even though only 25% of patients will ever need treatment. Identifying the 75% of patients who won’t need treatment early could make a large difference to resources.

The B-cell receptor (BCR) plays a key role in CLL, driving the disease by promoting the excessive growing and survival of leukemic cells. Recent advancements have identified two distinct subsets of CLL based on the BCR receptor: one subtype with unmutated BCR (labelled U-CLL) is linked to shorter time to first treatment (TTFT) and survival, and another with mutated BCR (known as M-CLL) associated with longer TTFT and survival. However, within each subtype TTFT and survival of patients are variable, and the Southampton group has discovered that other characteristics of the BCR, like their expression levels on the CLL cell surface or the strength of intracellular signals that they can provide, refines the probability of a patient to experience (or not) cancer progression over time.

This research aims to develop a new BCR-driven risk score to better predict which patients are at risk of disease progression, and who could benefit from early intervention. This score will be integrated with existing clinical data to improve patient care and reduce unnecessary monitoring.

Research Plan

The University Hospital Southampton (UHS) has introduced an innovative Patient-Initiated Follow-Up (PIFU) scheme. This allows patients to be remotely monitored by a specialist nurse-led team, with access to secondary care as needed. The goal is to identify suitable candidates for this scheme earlier, reducing the burden on healthcare services and improving patient experience.

The research will involve analysing data from a cohort of nearly 2000 patients. The team will study how much of a specific protein of the BCR complex, called surface immunoglobulin M (sIgM), is present on B cells, as well as how well it can send signals within these cells. sIgM is important because it has been linked to how long it takes for certain diseases to progress. By combining this information with other data, the researchers aim to develop a new tool to identify patients who are at a low risk of their condition worsening. These patients may then be eligible for a more flexible follow-up approach, known as patient-initiated follow-up (PIFU).