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ERIC CLL 2026 | Potential of early intervention in CLL: should the watch-and-wait strategy remain standard?
Alexey Danilov, MD, PhD, City of Hope, Duarte, CA, discusses the potential of early intervention in chronic lymphocytic leukemia (CLL), highlighting that the watch-and-wait strategy remains the standard of care, as studies such as CLL12 (NCT02863718) have shown no overall survival benefit with early intervention using treatments like ibrutinib. Prof. Danilov notes that early treatment can increase exposure to adverse events, but acknowledges the importance of ongoing studies like the EVOLVE CLL/SLL study (NCT04269902), which investigates early intervention with venetoclax and obinutuzumab in high-risk CLL patients. This interview took place at the 2026 ERIC International Meeting in Barcelona, Spain.
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Transcript
Yeah, I do believe that watch and wait strategy is the standard. In the era of chemoimmunotherapy, studies have shown that early intervention does not improve survival. We now have CLL12 study results, which randomized patients to ibrutinib, early intervention with ibrutinib or later intervention, and has shown that there is no benefit to overall survival, and yet patients get exposed to adverse events early, and essentially all of them experience some treatment-emergent adverse events with early introduction...
Yeah, I do believe that watch and wait strategy is the standard. In the era of chemoimmunotherapy, studies have shown that early intervention does not improve survival. We now have CLL12 study results, which randomized patients to ibrutinib, early intervention with ibrutinib or later intervention, and has shown that there is no benefit to overall survival, and yet patients get exposed to adverse events early, and essentially all of them experience some treatment-emergent adverse events with early introduction. So it doesn’t seem that by treating early, we are able to help patients live better or mitigate the adverse events. There is an ongoing study, a SWOG study, S1925, which specifically picks out patients with high-risk CLL, such as deletion 17p, complex karyotype, TP53 mutations, and randomizes these patients to either early intervention with venetoclax and obinutuzumab or late intervention with watchful observation, meaning at the time when those patients need therapy. I think that study is very reasonable and important because it really looks at the highest group of patients who we know will need treatment sooner or later and many of them sooner. So that study is powered on overall survival and will answer an important question. But until that study reads out, I wouldn’t propose treating patients early.
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