ERIC CLL 2026 | FLAIR insights: MRD-guided treatment duration in CLL and barriers to routine NHS adoption

FLAIR trial was a trial which was looking at a combination of, it had various arms in the trial which was comparing the targeted therapies as compared to chemoinmunotherapy. One of the arms used a combination of ibrutinib and venetoclax and then we used individual patient response based on MRD to dictate how long the patients are going to get therapy for. So what the data is showing now at this moment in time that the patients who’ve got unmutated IGHV status and they are classed as the standard risk patients, these are the patients who will benefit the most from MRD adapted approach. And really the bottom line of the trial is that if we use MRD at 12 months point or 18 months time point, it can tell us which patients will benefit from two or three years of therapy. And this data now shows that it leads to improved progression-free survival as compared to continuous therapy and actually overall survival difference as well. So I think the data is telling us that as we get more mature data coming through, and some of this will be presented at ASH this year, we will be able to say that if we use MRD adapted approach for standard or high risk patients, that will give us a better fixed duration option than what we have got now at this moment in time. Most of the physicians are defaulting to fixed duration therapies because in NHS we have to prove that any new therapy is not only clinically effective, and I would argue that we have shown that, but also cost-effective to a public healthcare system. In our system we now need to prove that if we give slightly longer duration of therapy, this will lead to a cost-effective treatment for the NHS as a whole. And we are in process of negotiation with the NHS England to get this approved for our UK patients.

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