From the Guidelines
Targeted therapy with BTK inhibitors (BTKi) and venetoclax is the preferred first-line treatment for all patients with chronic lymphocytic leukemia (CLL). This approach is based on the most recent guidelines, which prioritize disease stage, presence or absence of del(17p) or TP53 mutation, IGHV mutation status, patient age, performance status, and comorbid conditions when selecting a treatment regimen 1.
Key Considerations
- The choice of first-line treatment should consider the patient's overall health, genetic factors, and the potential toxicity of the treatment.
- For patients under 65 years with untreated IGHV-mutated CLL, FCR (fludarabine, cyclophosphamide, rituximab) is a preferred option.
- Effective treatment options for relapsed/refractory CLL include ibrutinib, idelalisib, acalabrutinib, duvelisib, and venetoclax combined with rituximab.
Treatment Approach
- Regular monitoring of adverse events and supportive care for treatment-related complications is crucial in managing CLL.
- Treatment duration varies, with some regimens requiring continuous therapy and others having a fixed duration.
- The treatment choice is guided by genetic testing, particularly for TP53 mutations or 17p deletions, which are less responsive to chemoimmunotherapy 1.
Monitoring and Follow-Up
- Regular monitoring of blood counts, symptoms, and response to treatment is essential throughout the treatment period.
- Relapsed disease often requires switching to a different drug class based on prior therapy response and duration.
From the FDA Drug Label
1 INDICATIONS AND USAGE
1.1 Chronic Lymphocytic Leukemia (CLL) BENDEKA® is indicated for the treatment of patients with chronic lymphocytic leukemia.
1.2 Non-Hodgkin Lymphoma (NHL) BENDEKA is indicated for the treatment of patients with indolent B-cell non-Hodgkin lymphoma that has progressed during or within six months of treatment with rituximab or a rituximab-containing regimen.
1 INDICATIONS AND USAGE
- 2 Chronic Lymphocytic Leukemia (CLL) RITUXAN, in combination with fludarabine and cyclophosphamide (FC), is indicated for the treatment of adult patients with previously untreated and previously treated CD20-positive CLL.
CLL Treatment Options:
- Bendamustine (IV): indicated for the treatment of patients with chronic lymphocytic leukemia 2
- Rituximab (IV): in combination with fludarabine and cyclophosphamide, indicated for the treatment of adult patients with previously untreated and previously treated CD20-positive CLL 3
From the Research
Treatment Options for Chronic Lymphocytic Leukemia (CLL)
- The treatment of CLL depends on the stage and physical condition of the patient 4
- Asymptomatic patients with early-stage CLL are usually not treated but are followed on a "watch and wait" principle 4, 5
- Treatment indications include stage Binet C or signs of an active disease, such as rapidly progressive lymphadenopathy or organomegaly, B symptoms, rapidly deteriorating blood values, or rapidly increasing leukocyte counts 4
Chemotherapy and Immunotherapy
- Immunochemotherapy with fludarabine, cyclophosphamide, and the CD20-antibody rituximab (FCR) is the standard of care in previously untreated and physically fit CLL patients 4
- An alternative regimen is the combination of bendamustine and rituximab (BR) 4
- Physically compromised patients can be treated with the oral drug chlorambucil or with bendamustine with or without rituximab 4
Targeted Therapies
- Targeted agents, such as ibrutinib, idelalisib, and venetoclax, have been approved for the treatment of CLL and have shown excellent outcomes, including in patients with high-risk disease 6, 7
- Venetoclax combinations, such as venetoclax-rituximab and venetoclax-obinutuzumab, have been shown to be effective in fit patients with CLL 7
Clinical Trials and Outcomes
- Clinical trials have compared the efficacy of different treatment regimens, including FCR, BR, and venetoclax combinations 7, 8
- Outcomes, such as progression-free survival and complete remission, have been evaluated in these trials 7, 8
- The results of these trials have informed treatment decisions and guidelines for CLL management 4, 6, 5, 7, 8