Conference Correspondent

Using a novel electronic health record database that included nearly 800 chronic lymphocytic leukemia (CLL) patients, recent (2015-2016) treatment patterns in the United States showed a decline in the use of fludarabine-, bendamustine-, and rituximab-containing regimens and a significant increase in the use of obinutuzumab and ibrutinib, either as monotherapy or in combination regimens. The uptick in use of ibrutinib was especially noted in CLL patients with del17p. The increased utilization of newer agents requires further follow-up and analysis to contrast treatment patterns beyond clinical trial data in a real-world setting and a cost-effectiveness analysis. 
Obinutuzumab, ibrutinib, and venetoclax can be safely administered in combination at doses standard for the treatment of patients with CLL, with manageable adverse events that were largely consistent with those reported in single-agent studies. Objective responses, including minimal residual disease–negative responses, were observed among all patients with relapsed/refractory CLL.
Using an ad hoc analysis of data from the RESONATE study, changes in clinical staging (by Binet or Rai) can identify different response categories among patients evaluated by the International Workshop on Chronic Lymphocytic Leukemia (IWCLL) criteria, and may be a useful and cost-effective method to evaluate treatment response at different time points over the course of the disease. Using this approach, the superiority of ibrutinib over ofatumumab in heavily pretreated CLL patients was confirmed and further elucidated.
Pembrolizumab has an acceptable safety profile in relapsed/refractory (R/R) chronic lymphocytic leukemia (CLL) and Richter’s syndrome (RS) patients and substantial therapeutic activity in RS. However, single-agent pembrolizumab does not appear to have significant therapeutic activity in R/R CLL.
An integrated safety analysis of treatment with single-agent ibrutinib for up to 5 years for patients with treatment-naïve or relapsed/refractory CLL/SLL revealed adverse events that were primarily grade 1/2 and were manageable with prolonged treatment.
The most important positive prognostic factor for 2-year nonrelapse mortality in chronic lymphocytic leukemia (CLL) patients following allogeneic hematopoietic stem-cell transplantation (alloSCT) is the donor HLA match. AlloSCT still remains a valid option for younger, high cytogenetic risk, refractory/relapsed CLL patients with an HLA-allele well-matched donor.
Ibrutinib enhances intrinsic JCAR017 activity and may improve outcomes in chronic lymphocytic leukemia patients treated with anti-CD19 CAR T therapy, irrespective of Bruton tyrosine kinase mutational status.
Treatment of elderly and/or unfit chronic lymphocytic leukemia (CLL) patients with chlorambucil plus rituximab is associated with low toxicity, a high overall response rate and durable progression-free survival, especially in patients with a mutated IGHV profile and not carrying del17p and del11q. In this low-risk subset of unfit patients, this combination could represent the optimal therapeutic option taking into consideration safety, efficacy, and cost.
In a single-center study, atrial fibrillation events in patients being treated with ibrutinib were generally manageable and, in the majority of cases, did not result in drug discontinuation.
Ibrutinib plus fludarabine/cyclophosphamide/rituximab (FCR) induces deep responses in previously untreated young patients with chronic lymphocytic leukemia (CLL), with 39% of evaluable patients achieving complete response with bone marrow minimal residual disease negativity (BM MRD-neg) and 89% achieving BM MRD-neg, significantly higher than the 20% rate seen historically with FCR alone.
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