iwCLL 2025 | Factors influencing the choice of first-line therapy in CLL

There are a number of factors that we can use. Certainly some of the genetic factors of CLL play into it. People who have high-risk features like TP53 abnormalities will probably do better with a continuous therapy than a fixed-duration treatment. Those that have very low-risk features who are open to a fixed-duration regimen, they’re ones that have the potential for maybe a functional cure with their first-line therapy. So those are kind of genetic features that play into this. 

Then there’s a lot of patient factors. So are there confounding medications or are there comorbid medical conditions that might make specific adverse events less desirable? And then of course things like patient preferences. Do they want to avoid intensive therapy? Do they want to do as much therapy as possible initially so that they can have less therapy later. 

So dependent on the choices of frontline therapy, it either creates more options for second line therapy or sometimes less options for second line therapy. And we just have to think about when we’re choosing our frontline therapy regimen, are we doing something that is going to allow more options later on? You know, if we’re doing a fixed-duration regimen, we could probably use those same drugs later on versus if we do a continuous therapy, that’s probably going to eliminate that treatment option later.

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