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ESH CLL 2026 | The influence of prognostic markers on frontline treatment choice in CLL
Matthew Davids, MD, Dana-Farber Cancer Institute, Boston, MA, discusses how prognostic markers such as IGHV mutation status, TP53 aberrations, and complex karyotype can influence frontline treatment selection in chronic lymphocytic leukemia (CLL), including the use of venetoclax-based combinations and continuous BTK inhibitor therapy for higher-risk disease. This interview took place at the ESH CLL 2026 congress in Stockholm, Sweden.
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Transcript
So there’s been a lot of discussion of the prognostic markers at this meeting around, you know, what effect they should have on the influence of frontline treatment choice. I would say for the low-risk patients with mutated IGHV, these are really patients who will benefit from any of these modalities, and that’s where I think specific comorbidities, patient preference can come into play...
So there’s been a lot of discussion of the prognostic markers at this meeting around, you know, what effect they should have on the influence of frontline treatment choice. I would say for the low-risk patients with mutated IGHV, these are really patients who will benefit from any of these modalities, and that’s where I think specific comorbidities, patient preference can come into play. But for most of my patients, I would recommend a venetoclax obinutuzumab-based regimen there because those patients can do exceptionally well with that treatment. For patients with the unmutated IGHV, the remission duration is a bit shorter with venetoclax obinutuzumab. So doing a venetoclax plus BTK inhibitor-based therapy is very reasonable in that group, as well as we could still consider continuous BTK therapy. And then particularly for those patients with high-risk disease, TP53 aberration, and then also patients with complex karyotype, we may want to consider still a continuous BTK inhibitor-based strategy to maximize the initial PFS until we have more data on retreatment after time-limited venetoclax-based therapies in the high-risk group.
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