Dr. Davids on the Use of Chemoimmunotherapy in CLL

Matthew S. Davids, MD, MMSc, director of clinical research in the Lymphoma Program and a medical oncologist with Dana-Farber Cancer Institute, as well as an assistant professor of medicine at Harvard Medical School, discusses the use of chemoimmunotherapy in patients with chronic lymphocytic leukemia (CLL).

One scenario where chemoimmunotherapy could be considered in CLL is in younger, fit patients who have mutated IGHV but do not have any aberrations in TP53. This means they don't have del(17p) or a TP53 mutation, says Davids. These patients can achieve durable responses with fludarabine, cyclophosphamide, and rituximab (Rituxan; FCR). Additionally, there is 12 to 15-year follow-up data available on some patients who are still in remission from their original 6 months of FCR, adds Davids.

However, patients still need to be counseled on risks with this therapy, including infections and prolonged cytopenias, as well as a late risk of myelodysplasia or even acute myeloid leukemia. These risks need to be discussed with patients, but if chemoimmunotherapy is used, that tends to be the population it is most applicable in, concludes Davids.