The road ahead for CLL care in sub-Saharan Africa

In this issue of Blood Global Hematology, Nzunda et al 1 report their results on TP53 testing in patients with chronic lymphocytic leukemia (CLL) by using a long-read sequencing platform at a tertiary center in Tanzania.Molecular risk stratification is highly relevant for prognostication and routine clinical decision-making in CLL management.Among the biomarkers that matter most, aberrations in TP53, either through deletion of chromosome 17p typically detected via fluorescence in situ hybridization (FISH) or point mutation of the gene itself, stand out as the strongest predictor of resistance to chemoimmunotherapy and even inferior outcome with targeted therapies.2,3 In this study, the authors present a prospective cross-sectional study evaluating Oxford Nanopore Technologies (ONT) sequencing as a feasible platform for TP53 mutational analysis in a cohort of 32 treatment-naive patients with CLL at a tertiary center in Tanzania.This work arrives at a critical juncture: as biomarker-driven treatment selection is standard in many countries around the globe, but the laboratory infrastructure required to deliver it remains unevenly distributed.