Two Onc Docs ASH 2025 LBA BRUIN-CLL 313 Update: Pirtobrutinib vs Bendamustine/Rituximab in 1L CLL
Dec 16, 2025
Dive into the latest updates on chronic lymphocytic leukemia treatment options! The discussion centers around the BRUIN-CLL 313 trial, comparing pirtobrutinib to the classic bendamustine/rituximab regimen. Key findings highlight a remarkable 24-month progression-free survival rate of 93.4% with pirtobrutinib. Explore the safety profile, common toxicities, and the implications for clinical practice. Plus, join in on the exciting future directions for CLL treatments involving novel agents and combination strategies!
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CLL Diagnosis: Flow And Markers
- Diagnose CLL with lymphocytosis >5,000/µL and confirm clonality by flow cytometry; bone marrow biopsy isn't always required.
- Key markers are positive CD19, dim CD20, CD23, and CD5; smudge cells appear on smear.
Treat Only Active CLL
- Only treat CLL when disease is active: symptomatic, cytopenias, threatened organ function, or progressive bulky disease.
- Observe asymptomatic patients without indications for therapy.
Pirtobrutinib Improves PFS Over BR
- Pertobrutinib, a non-covalent BTK inhibitor, showed superior 24-month PFS versus bendamustine-rituximab in frontline CLL (93.4% vs 70.7%).
- The trial used IRC-assessed PFS as the primary endpoint and allowed crossover from BR to pertobrutinib.