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ESH CLL 2026 | The challenges of choosing between continuous BTKis and fixed-duration venetoclax for CLL
Kerry Rogers, MD, The Ohio State University, Columbus, OH, discusses the challenges of choosing between continuous BTK inhibitors (BTKis) and fixed-duration venetoclax combinations for individual patients with chronic lymphocytic leukemia (CLL), considering factors such as biological features, comorbidities, and patient preferences. This interview took place at the ESH CLL 2026 congress in Stockholm, Sweden.
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Transcript
I think it’s really challenging these days to consider whether a continuous BTK inhibitor versus a fixed duration venetoclax combination might be best for an individual patient. These are all excellent choices, but they are somewhat different. I always like to think about the biologic features of the CLL, knowing that the best first-line treatment outcomes in terms of progression for survival are really with a continuous strategy with BTK inhibitors...
I think it’s really challenging these days to consider whether a continuous BTK inhibitor versus a fixed duration venetoclax combination might be best for an individual patient. These are all excellent choices, but they are somewhat different. I always like to think about the biologic features of the CLL, knowing that the best first-line treatment outcomes in terms of progression for survival are really with a continuous strategy with BTK inhibitors. So for patients with a TP53 altered CLL, I usually think about that. And then you see these very, very long remissions in IGHV mutated CLL with a fixed duration regimen. So if everything else is equal, I usually try to convince patients with IGHV mutated CLL to do a fixed duration regimen just because the durability is so good after a briefer treatment. But then you really have to think about comorbidities. If someone has atrial fibrillation that’s been very difficult to deal with, then you probably don’t want to use a BTK inhibitor. Granted, atrial fibrillation that’s controlled is okay, but when you have someone where that’s been a serious problem for them that can be really hard or if they’re on multiple drugs for high blood pressure and then with venetoclax, you know people with kidney problems or people that just have trouble getting to clinic, really that venetoclax start up with a tumor lysis risk reduction strategy and monitoring can be really burdensome. So I think about, like, some of the patient features. And then sometimes, especially for intermediate risk CLL, if, you know, patients don’t have comorbidities that make a difference, it really comes down to patient preferences about the convenience of continuous BTK inhibitors versus the fixed duration regimens. So you really have to understand not only someone’s, like, CLL risk features, but also their values for what matters most to them with treatment when you’re having these discussions. So it can be really complicated.
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