How to treat a previously untreated CLL patient

Barbara Eichhorst, MD of the University of Cologne, Cologne, Germany gives an overview of her talk on therapy for previously untreated patients with chronic lymphocytic leukemia (CLL) held at the 2016 International Workshop of the German CLL Study Group (GCLLSG) in Cologne, Germany. Dr Eichhorst points out that there are many treatment options available in frontline therapy now. For the fit patients, the FCR regiment is still the standard regiment. However, it has the disadvantage of late toxicities such as secondary acute myeloid leukemia (AML). There are maintenance treatment strategies as tested in the CLLM1 study (NCT01556776) where the question is if the remission duration can be prolonged by the addition of lenalidomide; results of this trial have been submitted to the ASH Annual Meeting. In the co-morbid patient, there are options for giving less toxic chemotherapy combinations, such as chlorambucil and bendamustine with antibodies (e.g. rituximab, ofatumumab or obinutuzumab). In terms of novel agents, ibrutinib monotherapy is approved in frontline therapy of CLL (RESONATE-2 trial, NCT01722487). However, the study that led to the approval of ibrutinib was done in elderly patients above the age of 65 and in comparison to chlorambucil. Dr Eichhorst explains that when frontline therapy is started in a patient, it is important to balance between either chemoimmunotherapy or ibrutinib therapy. Finally, patients with a 17p deletion can be treated in frontline with ibrutinib or idelalisib but more studies are required.

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