Frontline Therapy of Chronic Lymphocytic Leukemia: Changing Treatment Paradigm

Expert consensus on the management of chronic lymphocytic leukaemia in Asia

“…The trial failed to show the non-inferiority of BR, but a higher incidence of toxic effects was observed with FCR in patients > 65 years. A good efficacy with BR in this group may support the use of BR in fit elderly patients [ 34 , 38 ].…”

“…The majority of CLL patients with IGHV-m responded very well to FCR versus FC [ 33 ]. In comparison with the rest of the cytogenetics subgroups, patients with del17p, IGHV-u, and del11q demonstrated a shorter PFS, emphasising the need to investigate different therapeutic options [ 33 , 34 ].…”

“…Acalabrutinib is a second-generation, irreversible inhibitor of BTK with equipotent BTK inhibition as ibrutinib. It is associated with minimal off-target effects on other kinases [ 31 , 34 ]. In the phase III, multicentre ELEVATE-TN study, the efficacy of acalabrutinib was evaluated in treatment-naïve CLL patients (CIRS score > 6 and creatinine clearance of < 70 mL/min) [ 48 ].…”

Venetoclax consolidation after fixed-duration venetoclax plus obinutuzumab for previously untreated chronic lymphocytic leukaemia (HOVON 139/GiVe): primary endpoint analysis of a multicentre, open-label, randomised, parallel-group, phase 2 trial

“…tyrosine kinase (BTK), a key kinase involved in B-cell receptor signalling, and the B-cell lymphoma 2 (Bcl-2) protein, a crucial regulator of apoptosis. 2,3 Both the covalent inhibitors of BTK, such as ibrutinib, acalabrutinib, and zanabrutinib, and the selective Bcl-2 inhibitor venetoclax, have been shown to be highly efficacious as single-agent treatments in chronic lymphocytic leukaemia. 4 However, responses are mostly partial and a single-agent treatment requires continuous dosing until the occurrence of either unbearable toxicity or resistant disease, whichever occurs first.…”

Recognizing Unmet Need in the Era of Targeted Therapy for CLL/SLL: “What's Past Is Prologue” (Shakespeare)

“…The management paradigm for chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL) has undergone unprecedented changes over the last decade resulting in radically improved outcomes for patients (1,2). The previous cornerstone of treatment, cytotoxic chemotherapy, resulted in remission for many patients but also short-and long-term treatment-related morbidities (3).…”