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EHA 2026 | Does MRD-guided therapy have potential in CLL?
Matthew Davids, MD, Dana-Farber Cancer Institute, Boston, MA, discusses the potential of measurable residual disease (MRD)-guided therapy in chronic lymphocytic leukemia (CLL). Dr Davids notes that comparative studies are needed to demonstrate the benefit of MRD-guided therapy over fixed-duration therapy, and upcoming trials, including the CLL18 (NCT05677919) study and a US-based study of zanubrutinib-based regimens, will help address this. This interview took place at the 31st Congress of the European Hematology Association (EHA) in Stockholm, Sweden.
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Transcript
I think that MRD-guided therapy has real potential for CLL. We’ve seen studies like FLAIR with ibrutinib and venetoclax that use these individualized MRD-guided regimens. We’ve done some work ourselves with the AVO triplet, acalabrutinib, venetoclax, obinutuzumab in high-risk patients where we used an MRD-guided strategy. I think the challenge so far has been we don’t have comparative data to show that MRD-driven is better than fixed-duration therapy...
I think that MRD-guided therapy has real potential for CLL. We’ve seen studies like FLAIR with ibrutinib and venetoclax that use these individualized MRD-guided regimens. We’ve done some work ourselves with the AVO triplet, acalabrutinib, venetoclax, obinutuzumab in high-risk patients where we used an MRD-guided strategy. I think the challenge so far has been we don’t have comparative data to show that MRD-driven is better than fixed-duration therapy. But data like that are coming. So the CLL18 study is looking at pirtobrutinib and venetoclax, either MRD-guided or fixed-duration, compared to the venetoclax-obinutuzumab standard of care. And we’ll be launching a study in the U.S. looking at various zanubrutinib-based regimens, including zanubrutinib-sonrotoclax, fixed duration versus MRD guided. So to me, that’s one of the more exciting developments on the near horizon in CLL is that we might have prospective comparative data demonstrating a benefit of MRD guided therapy. And I think if we can do that, that would really kind of inspire people to use these MRD guided regimens.
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