iwCLL 2025 | Considering long-term treatment goals when selecting frontline therapy for patients with CLL

We’re really lucky in CLL that we have a lot of options for both frontline therapy and therapy for relapsed/refractory CLL. And because of that, it’s really important to start talking with patients prior to their first therapy about what are the goals of therapy, what are the realistic goals, and what can we do to make sure that they have as long and healthy life as they can with CLL. 

So I think initially when we’re thinking about frontline therapy, we have to think, is this a patient that has the potential to be cured by any therapy? Could they get, you know, something in the frontline setting? Like there are probably some patients who can be cured by our currently available doublets and triplets that are fixed-duration, though I think we don’t really know that that’s the case yet. But then we also know that there are some people who are going to be eligible to get CAR T-cells later on in therapy, that have the potential either to be cured by these modalities or to have a functional cure where their remission duration off therapy is going to exceed their natural lifespan. And if a patient is eligible for a therapy like that, if they’re interested in a therapy like that, we have to think about how we can sequence treatments in order to get them to that goal. As well for other people, the goal might be to have the most convenient therapy possible. They don’t want to come to the infusion center. They don’t want to come to the office as much as possible. We see a lot in people who are older, who have transportation issues, and also sometimes in younger people who have either child care responsibilities or responsibilities to their job or taking care of other family members. And for these people, we want to think about, you know, how can we give them a very long remission duration with something that is not going to be so disruptive to their daily life? And in many cases, those are continuous therapies. So really just ascertaining the patient’s goals, the patient’s preferences up front can help us really decide what’s going to be the best first-line therapy, get us to our goals with second line and beyond.

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