Dr. Wierda on Chemoimmunotherapy in CLL

William G. Wierda, MD, PhD, professor, D. B. Lane Cancer Research Distinguished Professor, section chief of Chronic Lymphocytic Leukemia, center medical director, Department of Leukemia, Division of Cancer Medicine, and executive medical director, The University of Texas MD Anderson Cancer Center, discusses the use of chemoimmunotherapy in treating patients with chronic lymphocytic leukemia (CLL).

Chemoimmunotherapy has been a very active strategy to get patients into remission and, over the years, regimens were developed to get as many patients as possible into complete remission, explained Wierda. However, that came at the cost of myelosuppression associated with these multidrug regimens that were developed. While chemoimmunotherapy got many patients in deep remission, they became less relevant for most patients with CLL due to the myelosuppressive effects, meaning the regimens could not be given to older patients.

For patients with mutated IgHV who received fludarabine and cyclophosphamide plus rituximab (Rituxan; FCR), there is a plateau on the curve and potentially includes patients who are cured from the treatment. These patients typically have a mutated IgHV and represent about 50% of the patients who are progression free ≥10 years after their initial treatment with FCR, making it a viable option. However, it is being used less currently, due to more effective options with targeted therapies, concludes Wierda.