CLL Coverage from Every Angle

SOHO 2021: Case-Based Look at First-Line Therapy for Younger Patients With CLL

By: Sarah Campen, PharmD
Posted: Wednesday, September 15, 2021

With the introduction of targeted kinase inhibitors—including ibrutinib, acalabrutinib, and venetoclax—over the past decade, the treatment of younger and fit patients with chronic lymphocytic leukemia (CLL) has evolved to integrate the use of these agents. A case-based discussion of the management of two young (< 65 years), fit patients requiring first-line therapy for CLL was presented during the 2021 Society of Hematologic Oncology (SOHO) Annual Meeting (Abstract EXABS-126-CLL).

“Young and fit patients with CLL have many efficacious options for front-line therapy,” explained Deborah M. Stephens, DO, of the Huntsman Cancer Institute at the University of Utah, Salt Lake City. “As such, all patients should be considered for enrollment on clinical trials if available.”

The first patient is a 61-year-old man with no significant medical comorbidities diagnosed with CLL; prognostic markers showed mutated IGHV and deletion of 13q. According to the results of the CLL8 Study, first-line CLL therapy with fludarabine, cyclophosphamide, and rituximab (FCR) improved progression-free survival in younger patients with IGHV mutation compared with patients without this mutation: the rate of 5-year progression-free survival was 67% versus 33%, respectively. The MD Anderson first-line FCR study supported the benefit in patients with IGHV mutation with 13 years of follow-up. This option is currently preferred over bendamustine plus rituximab if chemoimmunotherapy is selected, according to Dr. Stephens.

The second patient is a 59-year-old man diagnosed with CLL, with prognostic markers showing unmutated IGHV and TP53 mutation. Unlike the first case, chemoimmunotherapy is not a preferred treatment for this patient due to unmutated IGHV; instead, targeted agents are recommended in younger patients with CLL who have high-risk disease—or enrollment in a clinical trial. Although data for patients with TP53-mutated disease are limited, noted Dr. Stephens, ibrutinib has the longest follow-up supporting its use in this population. Acalabrutinib and zanubrutinib are potential alternatives, but data in the first-line treatment of TP53-mutated CLL is limited at this time, she added. 

Disclosure: No disclosure information was provided.

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