{
  "abstract": "Background: While international recommendations for prognostic assessment in chronic lymphocytic leukemia (CLL) are well established, uptake and standardization of recommended molecular testing appears variable across Latin America, and regional or national consensus guidance is limited. Aim: A streamlined Delphi survey aimed to identify barriers and solutions to the adoption of guidelines for the early identification of patients with high-risk CLL. Methods: A modified Delphi process was used, engaging CLL experts from Latin America. A literature review informed a Round 1 survey, assessing the status of CLL prognostic testing in Latin America. Agreement statements were then developed and evaluated across two themes (Round 2 survey): core guideline-recommended prognostic tests, and barriers with actionable recommendations. Responses were rated on a scale of 1 to 10 (1 = completely disagree, 10 = completely agree); agreement was defined as ≥ 75% of respondents rating a statement ≥ 6, in all rounds. Results: Thirty-four experts from ten Latin American countries participated (May 2024 to December 2025), including hematologists, immuno-oncologists, molecular pathologists, clinical geneticists, and medical technologists. All experts completed the Round 2 survey; fifteen completed Round 1 which was then expanded to increase representation of the Latin America region. Agreement was achieved for 24 of 36 (67%) statements. Key statements for guideline-recommended tests achieving agreement included: ‘Unmutated IGHV genes and TP53 mutations are associated with high-risk CLL, and mutation analysis informs clinical decision making’ and ‘It is not necessary to repeat IGHV gene somatic hypermutation analysis after the initial test’. Key statements achieving consensus regarding recommendations included: ‘Local adaptation of international guidelines would support a standardized approach to prognostication for all patients’, ‘Increased education of primary care physicians on the availability of guideline-recommended prognostic tests and risk stratification is needed to ensure appropriate escalation of care to specialists’, ‘Pathologist training programs should be implemented to standardize methodology for prognostic testing’, and ‘National and international registries would support understanding of the status of prognostic testing for CLL and identify any unmet needs’. Additional solutions achieving agreement included improved communication between laboratories and oncologists, standardized reporting, established referral pathways, funding to support best practice sharing, patient education, and expanded access to clinical trials and prognostic technologies. Discussion: The survey highlighted the clinical importance of IGHV and TP53 as prognostic biomarkers and aligned on barriers to the implementation of guideline-recommended prognostic testing for CLL. Conclusion: Investment in testing capacity, education, and locally adapted guidelines is needed to improve the uptake of prognostic testing for patients with high-risk CLL in Latin America. This research was funded by AstraZeneca. Medical writing support, under the direction of the authors, was provided by Kate Rees, PhD, of Helios Medical Communications, part of Helios Global Group, and was funded by AstraZeneca in accordance with Good Publication Practice guidelines (http://www.ismpp.org/gpp-2022).",
  "abstract_shown": true,
  "affiliations": [
    "Laboratorio Barnafi Krause, Chile",
    "Laboratorio Oncogenomics, AUNA, Peru",
    "Clínica Los Nogales, Colombia",
    "Institute of Experimental Medicine (IMEX), CONICET, National Academy of Medicine (ANM), Argentina",
    "IMTIB, Hospital Italiano de Buenos Aires, Argentina",
    "Dr. José Eleuterio González University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Mexico",
    "Hospital Del Salvador, Chile",
    "Hematology Service, Instituto Guatemalteco de Seguridad Social (IGSS), Guatemala",
    "Centro de Diagnóstico Molecular y Estudios Genéticos (CEDIMEG), Costa Rica",
    "Laboratório de Biologia Molecular, Centro de Transplante de Medula Óssea (CEMO), Instituto Nacional de Câncer (INCA), Rio de Janeiro, RJ, Brazil",
    "Independent Medical Affairs and Strategy Consultant, Singapore",
    "AstraZeneca, United Arab Emirates",
    "Institute of Applied Biosciences-Centre for Research and Technology Hellas (INAB-CERTH), Greece",
    "Hematopathology Section, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Spain"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 14,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Egon ÁLVAREZ VARGAS"
    },
    {
      "affs": [
        1
      ],
      "name": "Carolina BELMAR-LÓPEZ"
    },
    {
      "affs": [
        2
      ],
      "name": "Carlos CAMARGO MOLANO"
    },
    {
      "affs": [
        3
      ],
      "name": "Romina GAMBERALE"
    },
    {
      "affs": [
        4
      ],
      "name": "Hernán GARCÍA-RIVELLO"
    },
    {
      "affs": [
        5
      ],
      "name": "David GÓMEZ-ALMAGUER"
    },
    {
      "affs": [
        6
      ],
      "name": "Macarena ROA"
    },
    {
      "affs": [
        7
      ],
      "name": "Byron O SÁNCHEZ ROMERO"
    },
    {
      "affs": [
        8
      ],
      "name": "Carlos SANTAMARÍA-QUESADA"
    },
    {
      "affs": [
        9
      ],
      "name": "Ilana ZALCBERG-RENAULT"
    },
    {
      "affs": [
        10
      ],
      "name": "Ayman EL SAYES"
    },
    {
      "affs": [
        11
      ],
      "name": "Tamer AKL"
    },
    {
      "affs": [
        12
      ],
      "name": "Kostas STAMATOPOULOS"
    },
    {
      "affs": [
        13
      ],
      "name": "Dolors COLOMER"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/cxv75vq9pdwvc.bib",
  "cited_by": 0,
  "doi": "10.1016/j.htct.2026.107451",
  "fulltext_url": "http://www.sciencedirect.com/science/article/pii/S2531137926011983",
  "id": "cxv75vq9pdwvc",
  "issns": [
    "2531-1379",
    "2531-1387"
  ],
  "landing_url": "https://doi.org/10.1016/j.htct.2026.107451",
  "language": "en",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "lcc",
      "RC633-647.5"
    ],
    [
      "openalex",
      "2716|Chronic Lymphocytic Leukemia Research"
    ]
  ],
  "openalex": "W7223573511",
  "pdf_url": null,
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-23",
  "publisher": "Elsevier",
  "ris": "https://research.draconitic.com/paper/cxv75vq9pdwvc.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T13:43:37Z",
      "native_id": "dc857ebf06394732b34a3e6898dd4245",
      "source": "doaj",
      "url": "https://doi.org/10.1016/j.htct.2026.107451"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2716|Chronic Lymphocytic Leukemia Research",
      "subfield": "human-genetics"
    }
  ],
  "title": "IDENTIFYING BARRIERS TO THE IMPLEMENTATION OF RECOMMENDED TESTING GUIDELINES IN CHRONIC LYMPHOCYTIC LEUKEMIA: A DELPHI SURVEY IN LATIN AMERICA",
  "title_text": "IDENTIFYING BARRIERS TO THE IMPLEMENTATION OF RECOMMENDED TESTING GUIDELINES IN CHRONIC LYMPHOCYTIC LEUKEMIA: A DELPHI SURVEY IN LATIN AMERICA",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T13:43:37Z",
  "url": "https://research.draconitic.com/paper/cxv75vq9pdwvc",
  "venue": "Hematology, Transfusion and Cell Therapy",
  "versions": []
}