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Review
. 2024 May 25;16(11):2011.
doi: 10.3390/cancers16112011.

Treatment Sequencing in Chronic Lymphocytic Leukemia in 2024: Where We Are and Where We Are Headed

Alberto Fresa  1   2 , Idanna Innocenti  1 , Annamaria Tomasso  2 , Luca Stirparo  2 , Antonio Mosca  2 , Francesco Iadevaia  2 , Francesco Autore  1 , Paolo Ghia  3 , Luca Laurenti  1   2
Affiliations
Review

Treatment Sequencing in Chronic Lymphocytic Leukemia in 2024: Where We Are and Where We Are Headed

Alberto Fresa et al. Cancers (Basel). .

Abstract

As treatments with BTK inhibitors and BCL2 inhibitors have replaced the use of chemoimmunotherapy in CLL in both first-line and relapsed patients, it becomes critical to rationalize their use and exploit the full potential of each drug. Despite their proven, robust, and manifest efficacy, BTKis and BCL2is fail to provide long-term disease control in some categories of patients, and to date this is an unmet clinical need that is critical to recognize and address. Ongoing clinical trials are evaluating new treatment algorithms and new molecules to progressively thin this population. In this review for each category of patients we explicate the different possible patterns of treatment sequencing based on currently available evidence, starting from the frontline to currently ongoing trials, in order to optimize therapies as much as possible.

Keywords: CLL; acalabrutinib; ibrutinib; personalized; treatment; venetoclax; zanubrutinib.

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Conflict of interest statement

L.L. Janssen, Abbvie, AstraZeneca, Beigene: advisory boards, honoraria; I.I. Janssen, Abbvie, AstraZeneca, Beigene: advisory boards, honoraria; A.F.: Abbvie, AstraZeneca: honoraria.

Figures

Figure 1
Figure 1
Frontline treatment. Preferred cBTKis are acalabrutinib and zanubrutinib in most patients. Preferred treatment is in bold. cBTKi: covalent Bruton tyrosine kinase inhibitor, IGHV immunoglobulin heavy chain gene.
Figure 2
Figure 2
Treatment approach for previously treated CLL patients. Preferred cBTKis are acalabrutinib and zanubrutinib in most patients. Preferred treatment is in bold. Therapeutic alternatives with overlapping efficacy are in italics. cBTKi: covalent Bruton tyrosine kinase inhibitor, IGHV immunoglobulin heavy chain gene.
See this image and copyright information in PMC

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