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ERIC CLL 2026 | Choosing between fixed-duration and continuous BTK inhibitor therapy in newly diagnosed CLL
Marta Coscia, MD, PhD, University of Insubria, Varese, Italy, discusses the factors guiding her choice between a fixed-duration regimen and a continuous BTK inhibitor for patients with newly diagnosed chronic lymphocytic leukemia (CLL) who need therapy, including disease biology, patient characteristics, and logistics. Prof. Coscia highlights the importance of considering TP53 alteration status, immunoglobulin mutational status, infection risk, comorbidities, and patient preferences when making treatment decisions. This interview took place at the 2026 ERIC International Meeting in Barcelona, Spain.
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Transcript
The current guideline actually recommends that we take into consideration the biology of the disease and specifically the presence or absence of TP53 alteration and the mutational status of the immunoglobulins, but also the patient’s characteristics and specifically the risk of infection and the comorbidities, such as the cardiovascular comorbidity or the presence of renal insufficiency, and of course also the comedication that the patient could be administered during treatment...
The current guideline actually recommends that we take into consideration the biology of the disease and specifically the presence or absence of TP53 alteration and the mutational status of the immunoglobulins, but also the patient’s characteristics and specifically the risk of infection and the comorbidities, such as the cardiovascular comorbidity or the presence of renal insufficiency, and of course also the comedication that the patient could be administered during treatment. Another point that we should take into account is the logistics and therefore the patient preferences. So even for those patients where the biology would recommend a specific treatment, we should also consider, for example, to exclude obinutuzumab in the combination of venetoclax and obinutuzumab for patients with a high risk of infection or for patients with a logistic difficulty in dealing with an infusional therapy or to exclude a BTK inhibitor, especially ibrutinib continuous treatment in those patients who have cardiovascular comorbidity.
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