Oncology Brothers: Practice-Changing Cancer Discussions Treating and Managing Chronic Lymphocytic Leukemia (CLL) in 2025: Dr. Mazyar Shadman
Sep 11, 2025
Dr. Mazyar Shadman, a leading expert in lymphoid malignancies at Fred Hutch Cancer Center, discusses the future of Chronic Lymphocytic Leukemia (CLL) treatment. He emphasizes the importance of shared decision-making and explores the timing for initiating treatment. Key topics include the choice between time-limited venetoclax regimens and continuous BTK inhibitors, the significance of minimal residual disease (MRD), and innovative strategies for managing relapsed CLL, such as Pirtobrutinib and CAR-T therapies.
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Essential Pre-Treatment Workup
- Do obtain FISH, IGHV status, and karyotype before starting CLL treatment to guide therapy selection.
- Also assess cardiovascular risk, bleeding history, and patient logistics like travel and clinic access.
Ask About Time-Limited Versus Continuous
- Ask patients whether they prefer time-limited therapy or continuous therapy and explain the upfront logistics required for fixed-duration venetoclax regimens.
- Choose time-limited therapy only if patients accept weekly clinic visits and the ramp-up complexity needed for venetoclax.
MRD Doesn't Always Change Practice
- End-of-course MRD after venetoclax is measured but often does not change management; standard practice is to stop at planned duration.
- High-risk TP53 patients who are MRD-positive may reasonably continue therapy, but stopping remains the typical approach.