Dr. Brander on the Treatment Landscape for Patients With High-Risk CLL

Danielle Marie Brander, MD, assistant professor of medicine, Duke Cancer Institute, discusses the treatment landscape for patients with high-risk chronic lymphocytic leukemia (CLL).

High-risk patients with CLL have benefitted from recent novel therapies, says Brander, but their prognosis is still concerning. As a result of these novel therapies, patients are grateful that they do not have to receive chemotherapy, particularly if they are TP53 dysfunctional.

However, there is a subset of patients who are intolerant to the newer agents. Additionally, resistance poses an issue for a lot of patients, especially for those who develop resistance to ibrutinib (Imbruvica). In recent studies, patients who stopped or progressed on ibrutinib went to venetoclax (Venclexta) and showed greater than 60% response rates. However, physicians know that the patients who never experience a deep response eventually relapse.

Additionally, physicians are struggling to make recommendations for patients who develop acquired resistance to more than one novel agent. In those cases, Brander suggests other consolidation options such as allogeneic stem cell transplant. It is an area of need that may one day be met with chimeric antigen receptor T-cell therapy or immunotherapy, she says.