Goals of Treatment for Patients With Relapsed/Refractory Chronic Lymphocytic Leukemia (R/R CLL)

EP: 1.Clinical Case Scenario: A 55-Year-Old Patient With Chronic Lymphocytic Leukemia (CLL)

EP: 2.Currently Available Treatment Options for Patients With CLL

EP: 3.The Role of BTKi Monotherapy for CLL

EP: 4.Firstline BTKi Monotherapy in Patients With CLL: 4-Year Follow-Up Data from SEQUOIA

EP: 5.Firstline BTKi Monotherapy in Patients With CLL: 4-Year Follow-Up Data from ELEVATE-TN

EP: 6.Influence of BTKi-Related Adverse Event Patterns on Treatment Selection for Patients With CLLTN

EP: 7.The Role of Combination Venetoclax and BTKi Therapy for Firstline Treatment of CLL

EP: 8.Treatment Approaches in CLL After Disease Progression Following Combination Therapy With Venetoclax and BTKi

EP: 9.Clinical Case Scenario: Managing a Diagnosis of Atrial Fibrillation

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EP: 10.Goals of Treatment for Patients With Relapsed/Refractory Chronic Lymphocytic Leukemia (R/R CLL)

EP: 11.Role of Second-Generation BTKis in R/R CLL: Key Efficacy and Safety Data

EP: 12.Mechanisms of Resistance Observed With Covalent BTKis in CLL

EP: 13.Clinical Case Scenario: Management Strategies for BTKi Intolerance in Patients With CLL

EP: 14.Zanubrutinib in Patients with CLL and Intolerance to Prior BTKIs: Updated Phase 2 Study Data

EP: 15.BTK Inhibitor Treatment Strategies in Chronic Lymphocytic Leukemia

EP: 16.Key Data on Hypertension and Atrial Fibrillation in Patients With CLL

EP: 17.Impact of Treatment Duration on Development of BTKi-Related Atrial Fibrillation in Patients With CLL

EP: 18.Comparing Management of Hypertension versus Atrial Fibrillation in CLL

EP: 19.Future Perspectives in the Treatment of Chronic Lymphocytic Leukemia

Asher A. Chanan-Khan, MD, MBBS: Dr Parrondo, this patient and similar patients go from the first line, eventually get to relapse, or come in with relapsed or refractory [R/R] disease. I would like to hear your thoughts on what approach you take in the relapse setting. What are your goals, and how do you pick a therapy, especially if you have all these lists? How does the algorithm work when picking therapies for relapse or resistant therapy?

Ricardo Parrondo, MD: The goals of therapy for R/R CLL [chronic lymphocytic leukemia] are similar to first-line therapy. You want to alleviate constitutional symptoms, improve cytopenias, and alleviate bothersome splenomegaly and lymphadenopathy. You want to provide long-term disease control for the patient. And with all the available options, how do we sequence? We have several BTKis [Bruton tyrosine kinase inhibitors]. We have CD20 antibodies, BCL-2 inhibitors, and many emerging next-generation therapies, including noncovalent BTKis. There are PI3K [phosphoinositide 3-kinase] inhibitors. But my approach in the relapse setting is to stick with the most effective therapies, which are the BCL-2 and the BTKi. And the factors that guide, which of those to use, include what the previous therapy was. What was the response to the most recent therapy? Patient preferences again. Do they want all oral therapy? Do they want continuous vs time-limited therapy? What are the comorbidities of the patient? And do they have a TP53 mutation or not? So all those factors have to be taken into account when deciding on therapy for relapsed CLL. There’s no right or wrong answer. We know that you can use BCL-2; we have data. You can use a BCL-2 inhibitor after progression on a BTKi. We know that patients who got up-front venetoclax and obinutuzumab can be salvaged with a BTKi in the second-line setting, or you can rechallenge them with a venetoclax-based regimen. As I mentioned earlier, we have data for patients who got time-limited venetoclax; you can rechallenge them with a venetoclax-based regimen. So those are the factors that I take into account when deciding on therapy for relapsed CLL.