iwCLL 2025 | How MRD may reshape the treatment paradigm in CLL

During the last decades the role of MRD in CLL changed. Also because of advancements in technology, but mostly because we’ve seen really big, breakthroughs in therapy with novel therapies approved and widely used. So it shifted from prognostic use when it was a well-established prognostic marker with chemoimmunotherapy regimens. Now we rather think about using it as in MRD-guided strategies, as a predictive marker for instance to tailor the duration of therapy. Recent studies like CAPTIVATE MRD study or FLAIR showed that these MRD-guided strategies are feasible, but now we need confirmation from phase three studies comparing these MRD-guided strategies to standard treatment, fixed-duration treatment, and luckily such studies are ongoing. For instance, the MAJIC study, CLL18/MOIRAI study by the German CLL study group, or RESOLVE study by the ERIC group, and hopefully in a few years we will see the results. And I cannot predict it but I hope MRD will be used as a marker to guide therapy, so we will use it as a predictive biomarker to optimize the treatment in a way to deepen therapy or prolong therapy in those patients who respond suboptimally, but maybe most importantly, to limit the treatment duration in elderly patients with comorbidities who respond early with undetectable MRD.

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