VJHemOnc Podcast Updates to the ESMO CLL clinical practice guidelines and implications for relapsed therapy
May 8, 2025
Paolo Ghia, a leading expert in chronic lymphocytic leukemia (CLL) from Vita-Salute San Raffaele University, joins forces with Arnon Kater from the University of Amsterdam to discuss the latest ESMO clinical practice guidelines. They dive into innovative treatment strategies for relapsed CLL, including the use of the non-covalent BTK inhibitor pirtobrutinib and the promising roles of allogeneic stem cell transplantation and CAR T-cell therapy. The conversation also highlights the evolving landscape of therapies like BTK degraders and bispecific antibodies.
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Immunochemotherapy Obsolete With Novel Agents
- Immunochemotherapy no longer has a role if novel therapies are accessible for relapse refractory CLL patients.
- Treatment options narrow after prior therapy, typically favoring fixed-duration venetoclax plus rituximab following continuous BTK inhibitor resistance.
First-Line Choice Less Critical for Relapse
- Choice between fixed-duration and continuous frontline treatments doesn't heavily impact second-line options.
- Second-line approaches depend more on patient response and tolerability than initial treatment choice.
Test for TP53 in Relapsed CLL
- Always test for TP53 aberrations in relapse CLL to guide treatment decisions.
- Prefer continuous treatments for TP53 mutated patients; switch to venetoclax-based regimens upon resistance to BTK inhibitors.