Utilizing Maintenance Therapy for Chronic Lymphocytic Leukemia

Maintenance treatment with the CD20-directed monoclonal antibodies rituximab (Rituxan) or ofatumumab (Arzerra) yields better progression-free survival compared with observation alone in individuals with chronic lymphocytic leukemia (CLL) who have received induction therapy with chemo-immunotherapy, states Javier Pinilla-Ibarz, MD, PhD. This superior progression-free survival may be better achieved with the incorporation of a targeted B-cell receptor inhibitor, such as ibrutinib (Imbruvica) or idelalisib (Zydelig), adds Pinilla-Ibarz.

Patients tend to relapse sooner if they have more residual disease or are minimal residual disease (MRD)-positive instead of MRD-negative, notes Jennifer Brown, MD, PhD. Patients who have received chemo-immunotherapy and are in partial remission with measurable disease may be the most appropriate candidates for maintenance treatment with an anti-CD20 antibody, says William Wierda, MD, PhD. In his practice, Wierda does not typically consider maintenance therapy in individuals who are MRD-negative and in complete remission.

Brown does not typically favor maintenance treatment in patients who have developed significant cytopenias from chemo-immunotherapy, due to an increased risk of neutropenic events in these patients. Patients with significant infectious toxicity are also not the most suitable candidates for maintenance therapy, says Brown.