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EHA 2026 | The promise of MRD-adapted treatment strategies in CLL
Talha Munir, MBBS, MRCP, FRCPath, PhD, Leeds Teaching Hospitals NHS Trust, Leeds, UK, discusses the evolving role of measurable residual disease (MRD)-guided treatment in chronic lymphocytic leukemia (CLL). He outlines the potential advantages of tailoring treatment duration based on individual patient response, highlights the patients most likely to benefit from fixed-duration approaches, and reviews the evidence needed for MRD-adapted therapy to become part of routine clinical practice. This interview took place at the 31st Congress of the European Hematology Association (EHA) in Stockholm, Sweden.
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Transcript
I’ve been participating in this debate and focusing on the MRD-driven therapy for CLL. I think the main benefit of MRD-driven therapy is that it’s individualized based on response to, by individual patient to individual therapy, and then we can focus towards the duration of therapy. But I would try to argue that when we take a patient-focused approach and determine the duration of therapy, rather than arbitrarily saying everybody should get fixed-duration therapy, then we can improve the outcomes for our patients further...
I’ve been participating in this debate and focusing on the MRD-driven therapy for CLL. I think the main benefit of MRD-driven therapy is that it’s individualized based on response to, by individual patient to individual therapy, and then we can focus towards the duration of therapy. But I would try to argue that when we take a patient-focused approach and determine the duration of therapy, rather than arbitrarily saying everybody should get fixed-duration therapy, then we can improve the outcomes for our patients further. What I will try to show in this data set is that, especially for high-risk or intermediate-risk CLL patients, MRD-adapted approach probably will be giving better results than fixed-duration approaches and still better than continuous therapy. So the fixed-duration therapy would be still appropriate for patients with lower risk disease. And when we’re talking about IGHV-mutated CLL patients, as well as patients with 13q deletion, this might be an entirely reasonable option because these patients are going to do very well with fixed-duration therapy. Where my argument comes down to is the high-risk patients, where we are defining therapy, very effective therapy, but we’re choosing the length of therapy by just using a stop point, which I don’t think is right, in my opinion. In my view, the evidence is pretty clear, and we’ve got a very strong phase three trial, which has already reported out, though it was an academic study, one from the UK, showing that MRD-adapted therapy is superior to continuous therapy in terms of progression-free survival and overall survival. The complicating factor has been and has always been that MRD-adapted approach needs the availability of MRD to be done in clinical practice. But in my view, the evidence is there. And the next steps really are looking at a number of other phase three trials, which are looking at MRD-adapted approaches to be showing, which hopefully will show similar results to what we have already found in our studies.
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