Inhibitors of Bruton tyrosine kinase (BTK) have changed the standards of care in the setting of chronic lymphocytic leukemia (CLL). However, they do not eliminate leukemia, and undetectable residual disease is only very rarely achieved. Continuous treatment is therefore the standard approach, with the covalent BTK inhibitors ibrutinib, acalabrutinib and zanubrutinib being in widespread use as front-line single agents.

Fixed-duration venetoclax plus rituximab (VenR; n = 194) was tested against bendamustine plus rituximab (BR) for six months (n = 195) in the global, open-label, randomized phase III MURANO study that enrolled patients with relapsed/refractory CLL. In the experimental arm, 6 cycles of rituximab were administered, and venetoclax monotherapy was taken for a total of 24 months.

As covalent BTK inhibitors have been in use for the treatment of CLL in clinical practice for an extended period of time, different resistance mutations are being observed. Dr. Adrian Wiestner, MD, PhD, National Institutes of Health, Bethesda, USA, noted that mutations at progression are variable depending on the specific BTK inhibitor used, with the “classical” C481 mutations prevailing on ibrutinib and acalatinib treatment, while L528W mutations are mainly found in the context of zanubrutinib therapy.

The analysis reported by Davids et al. at iwCLL 2023 examined the characteristics, treatment patterns and outcomes of a cohort of 1,102 real-world US patients with CLL receiving two or more lines of therapy. Data were obtained from the COTA real-world database. Second-line treatment was initiated between 2014 and 2021.

The CLL Advocates Network (CLLAN) is a global network of patient advocacy organizations dedicated to improving the outcomes of patients with CLL through collaboration with national organizations. Principles guiding the work of CLLAN include the support of local communities, sharing of best practices and advocacy for better care and access.

Fortunately, the landscape of CLL treatment has dramatically transformed over the last ten years, shifting from chemotherapy to new targeted therapies. These advancements have not only extended patients' lifespans but also often enhanced their quality of life. Consequently, many patients now undergo continuous treatment throughout their lives and frequently pass away from causes unrelated to CLL. At this year’s iwCLL, there was a debate and roundtable on how to define success in CLL. From a physician's perspective, how is success in CLL treatment defined?